Emergency pack for children with cortisol deficiency

Information about the emergency pack available for children with cortisol deficiency.

This emergency pack contains one of each of the following:

  • One ampoule of hydrocortisone sodium phosphate 100mg/ml
  • „„Information leaflet on How to give an emergency injection of Hydrocortisone sodium phosphate 100mg/ml
  • „„One tube of fast acting glucose gel for rubbing into gums or cheek (Glucogel®)
  • „„Cotton wool ball
  • „„lcohol wipe
  • „„Syringe
  • „„Needle

Please check the expiry dates regularly. Ask for a replacement prescription from your doctor before the expiry date. Do not wait until you need to give an injection to check the expiry date.

Further information about hydrocortisone sodium phosphate for injection

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.

What is hydrocortisone sodium phosphate?

Hydrocortisone sodium phosphate 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 sodium phosphate 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 as hydrocortisone tablets given several times a day. 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. More information about cortisol deficiency is available in our Cortisol deficiency and steroid replacement therapy leaflet.

How is it given?

It is given as an injection into the muscle (intramuscularly). For instructions on giving intramuscular injections of hydrocortisone, please see the enclosed leaflet How to give an emergency injection of hydrocortisone sodium phosphate 100mg/ml: Information for families. 

You must always telephone 999 for an ambulance, stating that the child is having an ‘adrenal crisis’, if they have had a hydrocortisone injection.

Who should not use hydrocortisone injections?

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

  • „„Known hypersensitivity to hydrocortisone or any of its ingredients.

What are the side effects of hydrocortisone?

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. For information about these side effects and how they will be monitored, please see our Long term steroid treatment information sheet.

Hydrocortisone and other medicines

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.

Further information about glucose gel (Glucogel®)

Glucogel® is a glucose (dextrose) gel, which 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.

How to use Glucogel® after your child has had the hydrocortisone injection

Gradually squirt the Glucogel® into the side of your child’s mouth, between the gums and the cheek. Alternatively, squirt the Glucogel® 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’.
Compiled by: 
The Pharmacy & Endocrinology Departments in collaboration with the Child and Family Information Group
Last review date: 
September 2015
Ref: 
2015F0410

Disclaimer

Please read this information sheet from GOSH alongside the patient information leaflet (PIL) provided by the manufacturer. If you do not have a copy of the manufacturer’s patient information leaflet please talk to your pharmacist. A few products do not have a marketing authorisation (licence) as a medicine and therefore there is no PIL.

For children in particular, there may be conflicts of information between the manufacturer’s patient information leaflet (PIL) and guidance provided by GOSH and other healthcare providers. For example, some manufacturers may recommend, in the patient information leaflet, that a medicine is not given to children aged under 12 years. In most cases, this is because the manufacturer will recruit adults to clinical trials in the first instance and therefore the initial marketing authorisation (licence) only covers adults and older children.  

For new medicines, the manufacturer then has to recruit children and newborns into trials (unless the medicine is not going to be used in children and newborns) and subsequently amend the PIL with the approved information. Older medicines may have been used effectively for many years in children without problems but the manufacturer has not been required to collect data and amend the licence. This does not mean that it is unsafe for children and young people to be prescribed such a medicine ‘off-licence/off-label’. However, if you are concerned about any conflicts of information, please discuss with your doctor, nurse or pharmacist.