Ashley’s renin has been 18 before now.   Sometimes the renin will be out even after a missed tablet or so.  I’d say it is a big deal if a child does not reatin any sodium.  Even for just one day that would show in bloods if taken around the same time.   

The other week he missed lunchtime doses at school and then a dinner time dose.  It comprised of 50mcg of florinef in total, but was enough to make him crabby for a few days and when I checked his tray, I discovered the tablets still there.     Not to mention the missed cortef in all that.   I was more concerned that he had missed his piece of florinef than the cortef really though.  He always seems to be affected in that he cannot concentrate and get’s upset easily.  It is not surprising really as it is a lack of sodium and that means a lack of fluids, which in itself can cause any number of symptoms even when moderately dehydrated.  To name a few:

As dehydration increases, signs and symptoms develop. These include: thirst, restless or irritable behaviour, decreased skin turgor, dry mucous membranes, sunken eyes, sunken fontanelle (in infants), and absence of tears when crying vigorously.

Symptoms of early or mild dehydration include:

• flushed face
• extreme thirst, more than normal or unable to drink
• dry, warm skin
• cannot pass urine or reduced amounts, dark, yellow
• dizziness made worse when you are standing
• weakness
• cramping in the arms and legs
• crying with few or no tears
• sleepy or irritable
• unwell
• headaches
• dry mouth, dry tongue; with thick saliva.

That about describes him to a "T" when he misses part of a dose as he did.   So I guess to know those symptoms as a parent it would be helpful.   What is  most worrying is that when he is lacking florinef for whatever reason, he does not thirst as you would think he would.  If anything, you can barely get him to drink a drop and it is almost like he isn’t even interested in fluids.  It is only when he is well and the florinef is being absorbed properly and the sodium is given that he thirsts.  

I could not get his Doctor to understand that much really.  They think he is just not interested because he is ill or nauseous or whatever.  They don’t seem to understand that it is because he literally has no thirst.