dex, cortef or Prednisone, solu-cortef or Cortisone Acetate ,,,, whatever the point is ... This is right out of the PENS manual: CORTISOL DEFICIENCY MANAGEMENT DURING STRESS AND ILLNESS Your child does not make adeuate cortisol, a hormone that has many purposes in the body, including maintaining blood prssure, normal blood sugar, and resistance to infection. Normally cortisol is secreted in small amounts throughout the day. However, under periods of stress, such as severe infection, trauma, or anesthesia, a person normally has the ability to increase cortisol production ten times more than normal. Since your child has a definciency of cortisol, hydrocortisone must be given daily, and extra hydrocortiosne must be given during times of stress and illness. Give the injection immediately: 1. Vomiting 2 or more times in one day 2. Diarrhea 2 or more times in one day 3. Difficulty in arrousing or waking your child 4. Confusion or change in behavior (dizzy); unable to swallow 5. Decrese in appetite or fluid intake 6. Elevated temperature greater than 38.3 degree C or 101.3 - triple the oral dose immediately; if 38.5 or higher or 102 - GIVE THE INJECTION!! For vival or bacteria infection cause fever and is STRESS!! 7. Serious trauma, such as a broken bone, auto or bike accident 8. Surgery - the anestesilogist will give more cortisol by IV Overtreatment (too much) is better than undertreatment (no enough) for a child that appears sinificantly ill or stressed. You cannot hurt the child by giving the shot of cortisol. On the other hand, a child who needs the injection and does not get it can quickly go into shock and die for adrenal crisis. If ill, without adequate replacement of cortisol, the child's blood pressure will drip and child may become unconscience and die. This condition is life-threating. preston@kreative.net