Not to alarm you but my daughter Jessica died from an adrenal crisis and fever. She was only 2 years old.  It happened on 1 Sep 1997.  The ped endo doctor on call (adult endo) said to double the cortef and stop calling him.  In the morning she was in shock and died.  Double cortef was not enough.  Especially in 1997 because ped endo would not prescribe cortef in table form and the liquid cortef was re-called in 1998 because it was not manufacture right (it was not working).  She was not getting enough cortef because it was not mixing properly and I was afraid I would give her too much was in the back of my mind and the doctor was so insistent that I should double it and "stopping calling him".  I thought she needed sleep and she was in a coma.  She was rushed to the hospital but coma was too far gone and it took almost 2 hours to figure out what to do before they gave her an injection and IV. The doctor on call would not call them back. Her heart stop for 45 minutes. Somehow they revived but without 45 minutes of brain function. She was brain death on a respirator for 48 hours before they decide to take her off and let her go. Her eyes were fixed and she never moved. That is WHAT A FEVER CAN DO without more cortef.  And just letting the fever run it course.

Later I read that normal people without CAH make 4 to 10 times more cortef.  I later read that you give cortef immediately with the fever (say it is 9 am but you gave cortef at 7 am... you don’t wait until 3pm or the next dosage - you give cortef immediately - triple dose.  If the fever is over 101. If high fever 102 or more - give the injection.  Don’t wait.  You do not want to chance it. 

Do you understand? The fever can KILL this baby!! The fever should be reduced with mortin or tylenol.  Always have it available for the daycare.  And they must give it immediately and the fever needs to be reduced within 45 minutes to 1 hour or the stress from the fever will cause shock in a CAH child.  Triple the cortef immediately and continue every 6 hours. The underlying condition that caused the fever needs to be found too. Go to the emergency room. Find out why there is a fever.  The need to treat the injection. They need to check the blood sugars and salts. The blood pressure.  The coma was caused because her blood sugars and salts dropped with the lack of cortisol (cortef).... then the blood pressure dropped and then coma.  She was not sleeping. It was shock. She limp, eyes fixed.  All from a fever.

YOU CAN NOT GIVE TOO MUCH CORTEF if the baby is ill. You must give it immediately and every 6 hours.