A 13-year-old Caucasian m...

A 13-year-old Caucasian male patient exhibited symptoms such as inflexibility, irritability, impulsivity, agitation, aggression, anger, oppositional behavior, and persistent worry since childhood, with these symptoms intensifying over time. He also struggled with cognitive and executive functions, including difficulty following multi-step instructions and fine motor skills. He eventually engaged in self-injurious behaviors, expressed suicidal thoughts, and experienced anhedonia. He had undergone over 10 documented trials of psychotropic medications and had previously been hospitalized due to a suicide attempt. Before hospitalization, he received regular follow-up care from an outpatient psychiatrist and participated in therapy through an Applied Behavior Analysis (ABA) program. Upon his initial evaluation in the psychiatric ward, his physical examination revealed no abnormalities. His thought process was straightforward when directly questioned, although he selectively refrained from responding to specific queries. He denied any thoughts of self-harm or harm to others, hallucinations, or delusions. Subsequent lab results indicated an elevation in Blood Urea Nitrogen (BUN) and Creatinine (Cr), leading to further investigation to rule out underlying kidney disease. It was determined that he had prerenal azotemia (elevated BUN, with a BUN/Creatinine ratio >20) due to inadequate fluid intake, which resolved after appropriate hydration, requiring no additional medical interventions.