I tell ya, you will get many different responses here but I think they will all come down to the advice of injecting.

My daughter is 9 and has the salt wasting type of CAH. Since birth we have done the wait a few minutes, triple the dose of Cortef orally. If she holds that down, and no longer vomits, and looks and acts great we stay home from the E.R. and opt not to inject. This worked for us until this year. The first day of summer vacation when we thought it was finally a break from the flus and colds, she got hammered with a stomach virus. She barfed HUGE volumes. After she threw up, WITH NO FEVER MIND YOU, she said she was tired and wanted to sleep and was freezing. My husband bundled her up and laid her in her bed. She looked white, and too sleepy for my standards. She said she was freezing. I assumed it was from a high fever. I touched her and she was ICE COLD. I called her ped. endocrinologist to see if he could call ahead to get us into the E.R. and have him brief them. He told me to inject and bring her in. By the time I got up stairs my husband had stress dosed her orally. He said lets give it some time to work like it always has. I stupidly agreed and we headed to the E.R. She was like ice the entire way there. I kept telling my husband we should pull over to inject and he kept saying that would be wasting time getting to the E.R. We got her there, they took her right away, and they checked her blood pressure and it was low. They expedited her into a room where they pumped her full of IV fluids, SoluCortef, and that stuff they mentinoed above to stop the vomitting. She had stopped already but they wanted to make darn sure. She begged for water all the way to the E.R. I gave her tiny sips. Needless to say, I learned a new lesson in treating my daughter’s CAH. NEVER UNDERESTIMATE the power of the puking. I don’t know why in the past it has worked so well for us by just orally dosing. Maybe luck. But the endo. said that we still could have injected her despite the oral dose we gave her. He said it is much better to give too much than too little in a situation as this. I agreed and learned a valuable lesson. So even if you triple that dose of Cortef orally, and they still look really bad, KNOW that you CAN inject still. That is what my daughter’s Endo. told us. Better to be safe than sorry. And I was so sorry that night when they read her blood pressure. I beat myself up over it again and again but now have filed it in my "valuable lesson" file.