This is one I posted a few days ago... it is for the ER (how to treat and how long, etc). My son is 7 years old with salt wasting CAH.  You need to give sol-cortef before you go to the ER because they can make you wait too long and your child not die waiting in the ER waiting room or waiting on the solu-cortef to be ordered. They just don't have it waiting for you and they will take forever to order it.  The ambulance is also no help... they do not have solu-cortef and even if they did ... they will not inject it. You need to have it with you and know how to give it ... what if? and minutes count!!! You need to give within 30 minutes of the crisis... injury or whatever.

 

RE: Stephen Preston

DOB: 12/22/93

To Whom It May Concern:

 

Stephen Preston is a young man with congenital adrenal hyperplasia. Due to this condition, he is on medication that makes him adrenally insufficient. His regular medications are Cortef and Florinef

In the event of a high fever; that is 101 degrees F orally or greater, severe lethargy, serious injury or recurrent vomiting/diarreha, Stephen needs immediate attention. He should receive Solu-Cortef 100 mg IM or IV as well as IV hydration. The IV hydration should initially include normal saline at 10 cc per kg IV bolus, and then D5-D10 half normal saline at approximately 1 and 1/2 maintenance rate. In the event of severe hypoglycemia or hyperkalemia, a 10% dextrose solution may be beneficial. Any underlying condition should be treated. Obviously sepsis is a major concern in a young child with a high fever and hypertension. The IV hydration should be maintained for approximately 48 hours after the initial onset of the illness. As the illness improves, the hydrocortisone can be decreased by about 25% every 24 hours until maintenance dose is maintained. Usually by 48-72 hours the child can return to his maintenance Cortef and Florinef dosages. Blood pressure should be monitored as well as temperature and electrolytes. Because children with congenital adrenal hyperplasia can deteriorate quickly. Stephen will need to receive immediate attention.

If there is any questions about appropriate treatment or management for Stephen Preston, please do not hesitate to call Northern Virginia Endocrinologist at 703 849-4440. I can also be reached on my beeper, 703 550-4440. Please feel free to call.

Sincerely

Kathleen M. Link, MD