Protocol for stomach virus (October 2002)

NO - after vomiting once - wait 30 minutes and double the cortef!!! Do nothing!! No way!! Better be safe than sorry. Who is the world told you to do nothing?? I hope it wasn’t your doctor!! If he/she vomits even once - how can an oral medication be ingested in the system? Not to mention - dehydration, electrolyte imbalance. And it is triple the cortef for a fever over 101 degrees (f) and reduce the fever with tylenol or mortin. The fever needs to reduce within 30 to 45 minutes - or give the injection. My two year daughter died from an adrenal crisis and fever. The doctor said to double the cortef and stop calling me. GIVE the injection to be safe for a fever too. Solu-cortef is not just for vomiting. The child needs it for illness or physcial stress (fever). Normal people make 4 to 10 times more cortisol for illness... your child needs you to give the increased amount for illness. And do not wait. Do not wait because you had given a regular dose. Say the child had a 7 am dose of cortef and is sick at 9 am - triple the cortef at 9 am!! then repeat in 6 hours. Give the tylenol every 4 to 6 hours. If the child is sleeping - they may be in a coma - watch the blood pressure and oxygen levels. I prefer the motrin over the tylenol.

How old is the child? Can they tell you how they feel. A toddler or baby can’t tell you that they are going into an adrenal crisis. Even as older child or adult sometimes doesn’t realize that they are sick until it is too late. If you child is an infant - I hope you are using tablet form of cortef because the liquid is not effective treatment for CAH (it was recalled).

Sign of trouble or adrenal crisis or adrenal insufficiency are: lethargic, low blood pressure, vomiting, dizzy, light headed, lower back pain, lossing weight; darken of the skin in the folds or gential, etc (this is someone that has CAH and is not being treated). A CAH child that vomits daily, weekly or month - may not be getting enough cortef. This is a big RED FLAG!!

Of coures take tylenol and mortin with you. And some people swear by Phenergan (antiemetics) but personnal if I would only use it after the solucortef injection and IVs but it causes the child to sleep or lethargic and then is the child in a coma or asleep? (antiemetics should not be used by without prior consultation with a physician).

This the letter that I use but Laurel has five examples (Laurel posted it on her web site too - it is one of the five examples). I put over 101 fever give the injection because this letter was for the daycare at the Pentagon and the lawyers told be to be safe than sorry and not try to define want is a high fever - but 100 to 101 fever - triple the cortef but with a high fever - you ALWAYS give the solucortef injection... same thing with the amount of solucortef - yes you could give less depending on the situation but how do you define that situation).

________is a young child with congenital adrenal hyperplasia. Due to this condition, he/she is on medication that makes him/her adrenally insufficient. His/Her regular medications are Cortef and Florinef.

In the event of a high fever; that is 101 degrees F orally or greater, severe lethargy, or recurrent vomiting, __________ needs immediate attention. He/She should receive Solu-Cortef ___ 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 her maintenance liquid hydrocortisone and Florinef dosages. Blood pressure should be monitored as well as temperature and electrolytes. Because children with congenital adrenal hyperplasia can deteriorate quickly. _________will need to receive immediate attention.

If there is any questions about appropriate treatment or management for ___________, please feel free to call me at the _____________at 1-___-___-____ (Days) or 1-___-___-____ (After hours).