Hello! This, too, was a confusing issue for me. When Thomas was admitted to the hospital a third time, when he was three months old, they did not know why his salt was so high (he is a salt-waster), and was admitted for re-hydration. However, I posed this question to the endo and his residents, and he explained that, when the temp is 101 or higher, to triple the dose. Then, since he has a fever, you will be monitoring it every hour to every four hours, when you re-take it and it is high, then triple that dose. He has never indicated a need to just double the dose. So, I understood it to mean that you can triple the dosage every four hours, as needed, and to contact them if his temp remains high for more than one day, and if he is showing signs of dehydration. (the condescending resident stood there and clapped for me - that I finally understood; which angered me since the endo admitted they don't know everything, like why Thomas' salt AND potassium were both high. So, since he tends to run between 99.5 and 100.5 rectally, I triple the dosage at 100.9 and above. The endo said the danger in doubling and tripling the dose too often is that it could affect the growth. Hope that helps.