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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 curtsey of Great Ormand 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 that 1 year old, give them 0.25ml (25mgs) dose.

If you 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.

Photograph of 3 syringes with 3 different doses in for 3 different age groups. 0.25ml, 0.5ml, and 1ml

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.

If your hydrocortisone has come as a pre-mixed solution, click here for instructions.

Photograph of hydrocortisone, water for injection, needle and syringe

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

Photograph of opening water for injection and hydrocortisone

Open water for injection and hydrocortisone.

Photograph of attaching needle and syringe

Attach the syringe to the needle.

Remove the needle shield.

Photograph of drawing up 1ml of water

Draw up 1ml of water from container.

Photograph of removing air from syringe

Push the plunger in a bit to remove any air bubbles.

Photograph of drawing up hydrocortisone

Inject into the hydrocortisone dose.

Photograph of mixing in syringe

Use the needle to gently mix the solution in the hydrocortisone bottle.

Photograph of withdrawing hydrocortisone dose

Withdraw hydrocortisone dose.

Photograph of removing air from syringe

Push the plunger in a bit to remove any air bubbles.

Photograph of 3 syringes with 3 different doses in for 3 different age groups. 0.25ml, 0.5ml, and 1ml

Check the syringe for the correct dosage for your child.

If your baby is less that 1 year old, give them 0.25ml (25mgs) dose.

If you 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.

Photograph of finding injection site on patient's thigh

Find the middle part of the outer thigh and stretch the skin a bit.

Photograph of giving injection

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.

If your hydrocortisone has come as a powder and water that you need to mix, click here for instructions.

Photograph of hydrocortisone, needle and syringe

Check you have hydrocortisone, needle and syringe.

Photograph of tapping and breaking glass of hydrocortisone

Tap and break the top of the glass bottle of hydrocortisone.

Photograph of attaching needle and syringe

Attach the syringe to the needle.

Remove the needle shield.

Photograph of drawing up hydrocortisone

Withdraw hydrocortisone dose.

Photograph of removing air from syringe

Push the plunger in a bit to remove any air bubbles.

Photograph of 3 syringes with 3 different doses in for 3 different age groups. 0.25ml, 0.5ml, and 1ml

Check the syringe for the correct dosage for your child.

If your baby is less that 1 year old, give them 0.25ml (25mgs) dose.

If you 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.

Photograph of finding injection site on patient's thigh

Find the middle part of the outer thigh and stretch the skin a bit.

Photograph of giving injection

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.

My Cortisol App logo of a red needle with Great Ormond Street Hospital NHS logo

Contact us

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

If you have any questions or concerns, please contact the Endocrine Specialist Nurses Monday to Friday between 9am and 5pm on 0114 226 7815.

Or on evenings, weekends and Bank Holidays, call on 0114 271 7000.

Nurse Specialist in Late Effects (for getting a Letter for Customs) on 0114 305 3676.

Further resources

For more information please visit our other resources for adrenal insufficiency and adrenal insufficiency sick days.

Is something missing from this resource that you think should be included? Please let us know

Contact us

Disclaimer

Please note: this is a generic information sheet relating to care at Sheffield Children’s NHS FT. These details may not reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If this information has been translated into another language from English, efforts have been made to maintain accuracy, but there may still be some translation errors. If you are unsure about any of the guidance in this resource or have specific questions about how it relates to your child, always ask your healthcare professional for further advice.

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NHS

Western Bank
Sheffield
S10 2TH

United Kingdom

Switchboard: 0114 271 7000

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