Amanda was ill last week (5.5 years old).  Her temp stayed down pretty well on Wednesday (99-100's mostly, 101.3 at top).  She was 101.4 at 7:30 am Thursday morning (so another triple cortef dose & another Motrin dose).  Then her temp started rapidly rising within one hour and at 9:30 am, the thermometer heading into the 104 range.  Still no vomiting, no diarrhea, but a real sore throat (so not a very willing fluid-consuming patient now).  Amanda was starting to look out-of-it (tired, lethargic, red-faced, lip color changing).  I called the endo and she said to give the IM, even though just 2 hours earlier an oral triple dose was given.  And then go to the hospital ER after giving the IM.  I  gave 68.75 mg of solu-cortef ...well ... because of so much research saying 60 mg or 75 mg for her age .. I just mid-wayed it ... endo ok'd ... endo knows I get scared due to having had a CAH child die).   On the way to the hospital, Amanda's color was coming back, and she was perking up (talking, not so tired or lethargic anymore).   When we arrived at the hospital and her fever checked there, it registered 100.8 (70 minutes after giving the IM), and it stayed in the 99-100 range from then on.  I know on this board, we've had discussions about should the IM be given in "high fever only" cases (when not one instant of vomiting or diarrhea), so I wanted to share our story.  Both the endo & the endocrine nurse (both well-versed in CAH ... supposedly 125-150 CAH children patients in their endo dept) attributed her fever coming down (and her physical state coming back to normal) to the IM being given.  In our case, it appears that the 7:30 am meds (cortef & Motrin) were not at all absorbed into her system (even though not one instance of spitting up or vomiting, and she was keeping down fluids), and that is why the fever just kept going higher - Amanda was in an adrenal crisis.  I greatly appreciated that the endo had called the ER and said "Amanda is coming in, in an adrenal crisis, treat immediately" - and that the ER staff seemed to be familiar with what an adrenal crisis is, and that the endo came immediately down from her dept when we arrived.  Also, her glucose measured 124 (pretty high, a figure that would be after having a decent meal), and I could see some wonderment on the resident doctor's face when he saw it that high.  So I said to him, "glucose tablets, wow, looks like they really helped," (and he looked at me curiously enough), so I added, "she wasn't eating so normal yesterday, so I gave her a total of 3 glucose tablets because of the low blood glucose problem that arises in CAH people."  And along that note, all the literature saying "lethargy from low blood glucose in CAH patients," - we did have good blood glucose, but lethargy was present.  Good blood glucose is critical, if it goes low (30 or below), the person can enter into seizures & coma (blood glucose is the brain's food, and the oxygen transport system to the brain will fail).