Adrenal crisis is a form of shock, but not all shocks are adrenal crisis. In CAH, when the word shock is mentioned it usually means adrenal crisis. It is necessary to give your child an injection of fast acting hydrocortisone (injectable solucortef) in times of vomiting. Vomiting is a stress on the body that is usually controlled and appeased with production of cortisol in the body. In CAH, the lack of cortisol production perpetuates the vomiting where the individual is vomiting not because of any agents in the body causing it, but because the body is not capable of stopping it. This is full blown adrenal crisis, resulting in huge loss of glucose from the blood stream, causing lethargy and fainting, possible loss of sodium and dehydration. This is a time that without the injection of cortef and the trip to the hospital one can lose a loved one very quickly. We carry solucortef with us at all times. We leave vials with syringes and needles and directions at school. We were very lucky that at the time that we were not aware of the importance of having the solucortef with us our child did not go into adrenal crisis, but after her first crisis, which happened at home, we learned our lesson and now do not leave home without it! We give this shot when our child is vomiting and/or is severely lethargic and a triple dose of the oral cortef has not perked her up at all. The injectable is effective within half an hour of injection in the muscle, peaking around two hours and is gone by 4 hours post injection. If it is given IV it is instantaneously effective.