Advice after your nerve block for surgery
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Introduction
Hydrocortisone emergency injections are given to those with Addison’s disease, pituitary insufficiency or those with adrenal insufficiency secondary to steroids.
After diagnosis, you should be issued with a hydrocortisone emergency injection kit. This will include vials of hydrocortisone that either you or a friend or family member can administer if required.
Provision of a hydrocortisone emergency injection kit is standard practice and is the advice given by the ADSHG Clinical Advisory Panel, Society for Endocrinology, and on the NHS page for Addison's disease, for the prevention of an acute adrenal crisis in those with Addison’s disease, pituitary insufficiency or adrenal insufficiency secondary to steroids.
When to give an emergency injection?
You require an injection of hydrocortisone if you have any of the following conditions:
- Vomiting and unable to take your hydrocortisone tablet
- Severe diarrhoea
- Nil by mouth for any reason
- Suspected adrenal crisis
Use of hydrocortisone
Once you have your kit, both you and people that you spend a lot of time with, such as family, colleagues or friends, should learn what to do if you have an adrenal crisis and how to give an emergency injection of hydrocortisone.
Learning how to do this is very important. It doesn’t take very long and it could save your life.
After the injection has been given
It is essential that, after giving the injection, you contact your doctor to inform them of this, as you will need to be seen as soon as possible. Should you find difficulty contacting your own doctor, then it is important you attend your local Accident and Emergency department immediately.
Training to give the injection
This page explains how to give the emergency hydrocortisone injection.
Your prescriber should teach you or a designated person how to give an emergency hydrocortisone injection.
Contact your prescriber or your GP if you are unsure.
Storage
Choose a small sturdy box yourself to keep your emergency kit in. Ensure the box is clearly labelled. It is advisable to include the photo instructions on how to give the injection and NHS steroid emergency card in the box.
Regularly check your kit to make sure the vials are in date and request replacements for any that are out of date.
Further supply
Whilst the hospital makes up hydrocortisone emergency packs, that contain the hydrocortisone, diluent and supportive material, GP’s and local pharmacies do not. Instead, they will need to prescribe and supply the contents individually.
The following should be prescribed on an FP10 prescription by your specialist or GP:
- Hydrocortisone sodium succinate 100mg vial
- Water for injection diluent
- Sharps container
The following should be supplied from your GP surgery stock:
- Disposable syringe
- Blue needle 23G x 1 ¼
- Skin cleansing swab
Contact us to receive a replacement.
Further Information
Here are some useful resources which can be accessed if you have access to an electronic device:
- https://
www. addisonsdisease.org.uk/ newly-diagnosed-sick-day-rules - https://
www. addisonsdisease.org.uk/ the-emergency-injection-for-the-treatment-of-adrenal-crisis
For more information on this, or any related topics, please call Pharmacy Medicines Information on:
- Phone: 03006136751
- Email: fhft.
medicines. information @nhs.net
Prescribing and giving Hydrocortisone Sodium Succinate
| Equipment needed: Hydrocortisone sodium succinate 100mg vial, water for injection, syringe, needle and a skin-cleansing swab are all included in the hydrocortisone emergency kit |  |
| Twist the top off the Water for injection plastic ampoule and flip off the lid of the hydrocortisone vial, exposing the rubber bung |  |
| Remove the needle and syringe from the wrapper and attach the needle (still in its sheath) onto the end of the syringe. Carefully remove the sheath |  |
| Use the syringe to draw up 2mL Water for injection |  |
| Remove air by gently pushing up the plunger until a small drop of liquid forms at the top of the needle |  |
| Inject Water for injection through rubber bung of the hydrocortisone vial. Mix well by gently swirling |  |
| Withdraw dose from the hydrocortisone vial with the same syringe |  |
| Remove air from the syringe as above |  |
| Find site: the best site is the middle third of the outside of the thigh, but you could also inject into the muscle of the upper arm. |  |
| Give medication via intramuscular injection: at a 90 degree angle. Push the needle in completely. Depress the plunger of the syringe gently but firmly until all the contents are injected. Remove the needle quickly and apply a swab or tissue until the bleeding stops. |  |
|
Discard all vials and equipment in yellow sharps bin provided. Seek medical attention immediately. |
Contact us
If you have any queries relating to this information, please contact the Pharmacy service.
About this information
Service:
Pharmacy
Reference:
F/001
Approval date:
1 March 2024
Review date:
1 March 2027
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.