Chris, it sounds as if everything went just the way we have experienced things. Our son is about 16 months old, and, thankfully, he has only had one episode of vomiting, at which time he vomited 3 or 4 times consecutively. I immediately paged the endo on call, who asked me, "Well, does he look lethargic?" From all that I had read and seen with him, I knew that his appearance wouldn't necessarily indicate whether or not he was crashing, so I told him I was giving him the shot. He said, that, if it would make me feel better, he would make the call to the E/R to expect us for possible IV rehydration. We brought him in, and, of course, he was all around the waiting area, looking like the happiest well child you would have ever seen. However, appearances with these CAH children are deceiving, so I am convinced I acted in my son's best interests. They did go ahead and give him the sodium chloride bolus, and his electrolytes were fine. I don't think you were cavallier at all; just be thankful that you made it through this crisis. My former endo said that every experience teaches us how to manage him in the future. However, I know each situation is different, and I know the never quite sure feeling!