Have the doctor give instruction on increasing the medication for illness or injury.  Tell the school that you don’t plan on sending her/him to school sick but what if there is an sudden illness or injury? What if there is traffic for you? What if there is an accident with a car or on the playground?  What if??

 The medication needs to be at the school and with the school bus driver if she is on a field trip and you are not there.  You need a doctor order for sudden illness or injury.  Doctor’s order for 101 fever to triple the tablets;  Doctor’s order for tylenol or mortin.  Doctor’s order for the injection if the fever is 102; vomiting or diahrea or serious injury.

 You will find out that the ambulances will not give the mediations.  The fever is important because my daughter died from an adrenal crisis due to a fever ... so I do not play around with whether or not it is 101 or 102 or 103... I just tell them to give the injection and call an ambulance.  You can say -  101 fever - triple the cortef tablets; 102 or 103 fever - give the injection IMMEDIATELY.  But why chance it?  Same with vomiting and diahrea - give the injection for repeated vomiting/diahrea. IMMEDIATELY or within 30 minutes and call an ambulance.  Many children die in the waiting room waiting for instructions because young interns are cluesless on what to do.

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 hours after the initial onset of the illness.  As the illness improves, hydrocortisone can be decreased by 25% every 24 hours until 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