Date:

RE: child’s name

DOB:

Weight: …………kg  -  as of

 

To Whom it May Concern:

(Child Name) is a young man with congenital adrenal hyperplasia (classical salt wasting CAH).  Due to this condition he is on medication and is adrenally insufficient.  His regular medications are Cortef and Florinef.

In the event of a high fever, that is, an oral fever over 101 degrees Fahrenheit, when he has severe lethargy, recurrent vomiting, or severe injury that requires ambulance assistance, immediate attention is needed.  He should receive Solu-Cortef 100 mg IM or IV, as well 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 ½ the maintenance rate.  In the event of severe hypoglycemia or hyperkaliemia 10% dextrose solution should be given.

Any underlying condition should be treated.  Obviously sepsis is a major concern in a young child with a high fever and hypotension.  The IV hydration should be maintained for approximately 48 to 72 hours after the initial onset of the illness.  As the illness improves, hydrocortisone can be decreased by 25% every 24 hours until a maintenance does is maintained.  The child can usually return to his maintenance Cortef and Florinef doses within 48 to 72 hours.  Blood pressure should be monitored as well as temperature and electrolytes.  Because children with congenital adrenal hyperplasia (CAH) can deteriorate quickly, immediate attention is needed.

Do not hesitate to call me at XXX-XXX-XXXX or my beeper at XXX-XXX-XXXX,  

 

 

Sincerely,

 

Doctor’s Name