My two cents - it depends on the infection (how bad it is) and how she/he is feeling.  Very mild infection usually do not need more cortef.  And you don’t need more for a mild bump or bruise or scape or emotional upset.  You can’t overdose for severe infection or illness and she/he can die if you DON’t give increase.  Again the word is FEVER - always give more then!! ALWAYS!!! say you gave the 7 am dose and the fever starts at 9am - IMMEDIATELY increase!!! Don’t wait until the afternoon.  Give the increase every 6 hours with tylenol.  Write down the doses.   If too sleepy or won’t wake - give the injection IMMEDIATELY.

Look for signs these signs:

• unusual tiredness and weakness
• malaise, irritability, headache
• dizziness
• nausea, vomiting and diarrhea
• loss of appetite
• stomach ache
• low blood pressure
• hypotension, hyponatremia, hyperkalemia and hypoglycemia

Always increase if there is a fever!!! And give tylenol or motrin on schedule - wake for meds!!  ALWAYS - have the solu-cortef on hand!! Don’t think the ambulance or ER will be able to give it fast enough because they can’t do anything FAST.

Without a fever - look and see how she/he is feeling.  If she/he has the salt wasting form of CAH - give a sodium and sugar blood test and IVs (cortef, sodium, sugars).

Take sure you give the cortef medication on schedule (especially the 8 am dose - because of the hormonal surges) - wake for meds. Give extra fluids.