What Should I Do If My Child With CAH Vomits Hydrocortisone?

If your child throws up right after taking their oral hydrocortisone dose, the general rule of thumb is that the dose usually needs to be repeated. If a child vomits within 30 to 45 minutes of taking the medication, it likely hasn’t been absorbed yet. However, you should always follow the specific time window and instructions provided in your child’s written CAH emergency care plan.

Vomiting or severe diarrhea can quickly prevent your child from absorbing their life-saving medication. In fact, vomiting is the most common reason pediatric CAH centers advise parents to administer an emergency intramuscular (IM) hydrocortisone injection ^[1]. Gastrointestinal illnesses are frequent triggers for an adrenal crisis, a life-threatening emergency that occurs when cortisol levels drop dangerously low, especially in infants and toddlers ^[2][3]. For children with classic CAH, this can also lead to severe dehydration, dangerously low blood pressure, and abnormal sodium and potassium levels ^[1].

When to Administer the Emergency Injection

If your child vomits a second time, or if they cannot keep any oral fluids or medication down, do not keep trying to give them oral doses. You must act quickly to prevent an adrenal crisis:

1. Give the emergency injection: Administer your child’s prescribed dose of intramuscular Solu-Cortef (hydrocortisone sodium succinate) immediately ^[1].
2. Seek emergency care: Call for an ambulance or head to the nearest emergency room. Inform the medical team that your child has CAH, is at risk for an adrenal crisis, and has received an emergency injection.
3. Hospital assessment: Urgent medical assessment is required. The clinical team will evaluate your child’s hydration, electrolytes, and blood sugar to determine if they need intravenous (IV) fluids, additional hydrocortisone, or hospital admission ^[1].

Recognizing Severe Signs of an Adrenal Crisis

An adrenal crisis can develop rapidly. Do not wait for a second vomiting episode if your child shows severe symptoms. Give the emergency injection immediately and call emergency services if your child exhibits any of the following:

• Extreme fatigue, unusual sleepiness, or being very difficult to wake up ^[1][4]
• Dizziness, profound weakness, or collapse ^[4]
• Signs of low blood sugar (hypoglycemia), such as jitteriness, low body temperature, or seizures ^[4]

Safety Note: Never give food, drink, or oral medication to a child who is excessively drowsy, seizing, or unable to safely swallow, as this can cause them to choke or inhale fluid into their lungs.