What to do in an emergency -Emergency Injections

By:  Katherine White & Suzanne Curran   Friday, 3. October 2003

In an emergency, anyone with Addison’s disease can experience symptoms of extreme weakness, a serious drop in blood pressure and mental confusion.  This means they need extra steroid medication immediately, and may need an emergency injection. 

As a general rule, an Addisonian should give themselves an emergency injection of 100mg hydrocortisone sodium (Efcortesol or Solu-Cortef) if they vomit more than once.

Our thanks to endocrine nurse Suzanne Curran, who has been our main adviser on injection kits.

Maintaining your injection kit 

1.      What is in an injection kit?

• An injection kit consists of:

  • Injectable steroid (usually enough for 2 injections).

  • Syringes

  • Needles

• You will usually need to find your own container for these items.  Small plastic pencil cases or lunchboxes can work well, or you can order an insulated container from your chemist.

2.      Who prescribes the injection kit?

• Your GP can prescribe the emergency injection kit for you. Your endocrinologist can recommend the type of kit if you are unsure which will suit you best. 

• If your injection kit has been prescribed by an endocrinologist, the hospital pharmacy will issue you with needles and syringes as well as the injectable steroid.  If your injection kit has been prescribed by a GP, then the GP’s surgery should supply you with the needles and syringes.  A commercial pharmacy can sometimes issue you with needles, but many will not keep them on the premises.

• The advantages and disadvantages of the different injection types are described below.

2.     Training in how to use it

• Your GP or the practice nurse can show you and your partner how to give the injection.  Hospital-based endocrine nurses are also able to give training. 

• It is important for your partner or a companion to know how to give the injection, in case you ever become too weak or confused to give the injection yourself.

• We suggest you request a refresher practice session on giving an injection every time your injectable steroid reaches its expiry date and needs replacing, that is about every two years.

3.     Keep it close at hand

• It is best to keep an emergency injection kit at home and to always take one with you when travelling. Frequent travellers may need to keep a spare kit in the car.

4.     What is the standard injection kit?

• In the UK, the standard emergency injection is:

  • Efcortesol (hydrocortisone sodium phosphate) 100mg.

• We suggest you keep at least 2 vials of Efcortesol for emergency use. 

• Efcortesol is best stored in the fridge, but is stable at room temperatures up to about 25 degrees Celsius.  Keeping it the fridge has the advantage that it is easy for family or friends to locate if you need assistance. (You might then want to warm the vial in your hands for a minute before drawing up the injection.  But injecting the chilled solution straight from the fridge is fine).

• If your Efcortesol is stored out of the fridge, check that it has not deteriorated in hot weather - it will go cloudy if it has.

• Check that your injection vials remain in date and remember to replace them before they expire. Most have a two year lifespan.  We suggest you mark the front of the pack with the expiry date so you have a clear reminder.

5.     Alternatives to Efcortesol

• There is a powdered form of injection kit available as an alternative to Efcortesol:

  • Solu-Cortef (hydrocortisone sodium succinate) 100mg, plus vials of water for mixing

• Solu-Cortef is more complicated to administer as it is a powder which must be mixed with saline before it is injected. The advantage of Solu-Cortef is that it is more stable in higher temperatures. Therefore, it is a sensible choice when travelling and may be a better choice for the car.

• There are a number of other forms of injectable steroid. In general, injectable steroids which have a sodium base, such as dexamethasone sodium phosphate or methylprednisone sodium succinate, are suitable for emergency use.

6.     Check that your prescription has been correctly supplied

• Some injectable steroids are not suitable for emergency use. These include all acetate-based solutions, especially hydrocortisone acetate. Acetate-based steroid injections are slow-acting and are most suitable for treating conditions such as arthritis.

• We suggest you should always check your prescription to ensure that your prescription has been correctly filled.  Points to watch for include:

  • That you have not been given hydrocortisone acetate by mistake.

  • That you have been given both the vials of powder and the vials of water for mixing it for a Solu-Cortef prescription.

  • That you have been given the right sized needles (0.5mm or 0.6mm is standard for intra-muscular injections) and syringes.

7.     Remember to seek medical help

• The injection kit is intended to stabilise your condition while you wait for medical help, not as a replacement for medical care. 

• You may need intravenous saline to stabilise your condition and will benefit from medical monitoring.

• Once you have given yourself the injection, please seek immediate medical help.  We suggest you either request a house call from your GP, or get someone to take you to the Accident and Emergency Department.  If you are feeling extremely unwell and there is any doubt as to how quickly your GP could see you, we suggest you ask your GP to arrange an ambulance to take you directly to Accident & Emergency. 

Summary: injection kit contents

1.       Prescription only: injectable steroid.  Usually either:

• Efcortesol (hydrocortisone sodium phosphate) 100mg, or

• Solu-Cortef (hydrocortisone sodium succinate) 100mg, plus vials of water for mixing

2.      Accessories provided by either GP’s surgery or hospital pharmacy

• Syringes

• Needles, 0.5mm or 0.6mm for intra-muscular use

Compiled by Katherine White and Suzanne Curran

September 2003

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