First thanks for your effort in presenting us a great book. I was reading the chapter on Mineralocorticoid Treatment and Monitoring in CAH. On page 146, you mentioned that a CAH patient "can go into crisis even with normal electrolyte levels. In this event, renin will be elevated". I don’t quite understand this. I thought ardrenal crisis is always exemplified by electrolyte imbalance. If a CAH patient has normal electrolyte levels, what else can cause him/her go into crisis? Or is it just because they use "different" ways to test electrolyte and renin? (the electrolyte reflects the relative value of sodium and potassium vs. renin reflects the total sodium in the body?).

What lab tests can confirm he/she is in the crisis? I’m asking this question since it is not possible to get a renin test in time in ER, how would a parent to convince the ER staff that the child is in crisis? Is bicarconate level the one we should look? How about chloride? What’s the correlation betwwen chloride and bicarconate ?

Thanks.