Hydrocortisone sodium phosphate and hydrocortisone sodium succinate emergency injection packs

Your specialist treatment centre will issue you with three emergency medication kits, one of which your child should carry at all times. Others should be kept at home and at your child’s nursery, school or college.

You should keep this in a box or a tin that closes securely.

Each kit should contain:

• hydrocortisone issued as:
  • one vial of 100mg/1ml  hydrocortisone sodium phosphate OR
  • one vial of 100 mg hydrocortisone sodium succinate powder and one vial of water for injections (dissolve all of the powder in 1 ml of water)
• one 2ml syringe
• two blue needles
• one tube of glucose gel  with instructions for use
• one leaflet ‘How to give an emergency injection of hydrocortisone'
• one steroid card filled in with child’s details
• a copy of your ambulance protocol
• some spare oral tablets of hydrocortisone  

You should check the expiry dates of hydrocortisone tablets, injection and glucose gel and order replacements from your family doctor (GP) before they pass their expiry date.

The following information describes hydrocortisone for injection, how it is given and some of its possible side effects. Each person reacts differently to medicines so your child will not necessarily suffer every side effect mentioned. If you have any questions or concerns, please ask your doctor, nurse or pharmacist or telephone one of the contact numbers below.

Hydrocortisone is a corticosteroid (steroid). Steroids are hormonal substances that are produced naturally in the body by the adrenal glands (which are just above each kidney) and by the reproductive organs. There are many different types of steroids and they have different effects on the body. They are different to the anabolic steroids used by athletes to enhance their performance.

Hydrocortisone is used to treat children who have cortisol deficiency. Cortisol deficiency occurs when the adrenal glands do not produce enough cortisol. Cortisol deficiency is easily controlled with replacement therapy with hydrocortisone tablets. However, if a person with cortisol deficiency becomes unwell, they are unable to increase the production of cortisol in their system to help the body cope and this could be life threatening. If this happens and they are unable to take extra oral hydrocortisone, they will need an emergency injection of hydrocortisone sodium phosphate or hydrocortisone sodium succinate.

The cortisol deficiency webpage contains more information about when to administer emergency hydrocortisone injections.

Both hydrocortisone sodium phosphate and hydrocortisone sodium succinate are given as an injection into the muscle (intramuscularly). After giving these injections you must always telephone 999 for an ambulance, stating that the child is having an ‘adrenal crisis’.

People with the following conditions should discuss using hydrocortisone with their doctor:

• known hypersensitivity to hydrocortisone or any of its ingredients

Allergic reaction – Some children receiving hydrocortisone may have an allergic reaction to the drug. This reaction may be mild to severe. Signs of a mild allergic reaction include skin rashes and itching, high temperature, shivering, redness of the face, a feeling of dizziness or a headache. If you see any of these signs, please report them to a doctor or nurse.

Signs of a severe allergic reaction include any of the above, as well as shortness of breath or chest pain. If you are in hospital and your child shows signs of a severe allergic reaction, call a doctor or nurse immediately. If you are at home and your child shows signs of a severe allergic reaction, call an ambulance immediately. If your child has a severe reaction to hydrocortisone, the subsequent treatment will probably be changed.

Other side effects are likely to be related to your child’s everyday steroid treatment.

Some medicines react with hydrocortisone, altering how well it works, although this is unlikely when hydrocortisone is given as an emergency dose. However, always check with your doctor or pharmacist before giving your child any other medicines, including herbal or complementary medicines.

Glucose gel can be used when your child is showing signs of low blood sugar levels. It should always be used in addition to giving the hydrocortisone injections.

Gradually squirt the glucose gel into the side of your child’s mouth, between the gums and the cheek. Alternatively, squirt the glucose gel onto your fingertip and apply it between your child’s gums and cheek.

• Massage your child’s cheek to allow the gel to be absorbed.
• This should raise your child’s blood sugar level within 10 minutes.
• Telephone 999 for an ambulance, stating that your child is having an ‘adrenal crisis’.

• Keep the entire emergency pack together in a box or tin that closes securely, in a safe place where children cannot reach it.
• Keep it at room temperature, out of direct sunlight or heat.
• Remember to check the expiry date of the pack before your hospital appointment so you can order a replacement if needed.
• If your doctor decides to stop treatment, return any unused pack to the pharmacist. Do not flush them down the toilet or throw them away.