How to give emergency injection of hydrocortisone

This resource is for giving an emergency injection of hydrocortisone for adrenal deficiency (adrenal crisis).

All images used with courtesy of Great Ormond Street Hospital.

In emergencies, phone 999 and ask for a paramedic ambulance. Tell the paramedics that your child has adrenal insufficiency and is on steroid replacement.

When to give emergency hydrocortisone?

You need to give your child an emergency dose of hydrocortisone if they:

• are very unwell with diarrhoea and being sick, and not able to take medication by mouth
• are unconscious or not very responsive
• have low blood sugar (hypoglycaemic)
• new onset seizure
• have a broken bone or fracture
• have a significant burn
• have been in a road traffic accident
• head injury with loss of consciousness

How much hydrocortisone?

If your baby is less than 1 year old, give them 0.25ml (25mgs) dose.   If your child is 1 to 5 years old, give them 0.5ml (50mgs) dose.   If your child is 6 years and older, give them 1ml (100mgs) dose.

How to give hydrocortisone

Powder and water

If your hydrocortisone has come as a powder and water that you need to mix, follow the instructions below.

1. Check you have hydrocortisone, water for injection, needle and syringe.
2. Open water for injection and hydrocortisone.

3. Attach the syringe to the needle. Remove the needle shield.
4. Draw up 1ml of water from container.

5. Push the plunger in a bit to remove any air bubbles.
6. Inject into the hydrocortisone dose.

7. Use the needle to gently mix the solution in the hydrocortisone bottle.
8. Withdraw hydrocortisone dose.

9. Push the plunger in a bit to remove any air bubbles.
10. Check the syringe for the correct dosage for your child.

11. Find the middle part of the outer thigh and stretch the skin a bit.
12. Hold the syringe like a dart at 90 degrees. Push in the needle completely and plunge the syringe gently but firmly until all the medicine is injected. Quickly remove the needle and use a tissue to stop the bleeding.

Dispose of needle carefully.

Pre-mixed solution

If your hydrocortisone has come as a pre-mixed solution, follow the instructions below.

1. Check you have hydrocortisone, needle and syringe.
2. Tap and break the top of the glass bottle of hydrocortisone.

3. Attach the syringe to the needle. Remove the needle shield.
4. Withdraw hydrocortisone dose.

5. Push the plunger in a bit to remove any air bubbles.
6. Check the syringe for the correct dosage for your child.

7. Find the middle part of the outer thigh and stretch the skin a bit.
8. Hold the syringe like a dart at 90 degrees. Push in the needle completely and plunge the syringe gently but firmly until all the medicine is injected. Quickly remove the needle and use a tissue to stop the bleeding.

Dispose of needle carefully.

My Cortisol app

Great Ormond Street Hospital have developed a free training app for giving an emergency injection of hydrocortisone. The app is a real time video showing the technique. There is also space to record your child’s doses and emergency plan. The My Cortisol app is available for both Apple and Android devices.