GUIDELINE TO EMERGENCY CARE
WHILE TAKING HYDROCORTISONE

1. Do not stop giving yourself / your child hydrocortisone without first talking to your physician. This medication may have serious withdrawal effects.
2. NOTIFY ALL OF YOUR/YOUR CHILD’S PHYSICIANS THAT HE/SHE IS TAKING THIS MEDICATION. Carry these instructions with you at all times in case of an emergency or accident. It is advised that your child wears a medical bracelet with this information on it:

As an example the Medic Alert bracelet may state:
ADRENAL HORMONE DEFICIENCY-GIVE HYDROCORTISONE INJECTION IN EMERGENCY

3. If you or your child has a fever (greater than 101 F), severe injury or serious infection and if he/she is able to take this medication by mouth, you will need to increase this dose by 2 or 3 times at each medication time until the fever is gone or his/her condition is stable, and contact your / your child’s physician to inform him/her of the situation whenever you increase the dose.
4. If you/your child is unable to take the medication by mouth because of repeated vomiting, or if he is rapidly becoming sleepy or unconscious,, you/your child will require an injection of Hydrocortisone, the brand name is
Solu-Cortef- 25mg=0.5cc for infants, 50mg=1cc in children, 100mg=2cc in adolescent & adults.
Inject into the muscle one time for coverage.

Then notify your child’s physician as:

THIS IS AN EMERGENCY TAKE YOUR CHILD TO A NEARBY EMERGENCY ROOM
IMMEDIATLEY

FOR THE EMERGENCY ROOM PHYSICIAN:

In the situation of adrenal crisis the patient will need:
1) Immediate IV normal saline with 5% glucose 20ml/kg in one hour followed by continuous and appropriate IV fluid replacement in children and a liter of normal saline with 5% glucose in 2 hours in adults followed by continuous and appropriate IV fluid replacement.
2) Solu-Cortef 25mg IV bolus in small children younger than 3 years. 50mg IV bolus in children between 3 and 10 years of age, and 100mg IV bolus in adolescents and adults. Thereafter during the time of acute crisis, administer for infants Solu-Cortef 20-30mg/day by IV drip or in 4 divided doses IM or IV; for young children 40-50 mg/day and for older children 50-60 mg/day by continuous IV drip or in four divided doses IM/IV; and for adolescents or adults 80-100mg/day by continuous IV drip or in 4 divided doses by IM or IV.

DIRECTIONS FOR MIXING THE CORTEF -ACT-O-VIAL TO BE GIVEN INTO THE MUSCLE (IM)
1.Press down to force the diluent into the lower compartment.
2. Gently agitate to mix solution, use only if solution is clear.
3. Remove the center disk of the protective cap.
4. Sterilize top of plunger-stopper with alcohol swab.
5. Insert needle squarely through the center of the plunger-stopper until the tip is just visible.
6. Invert vial and withdraw the dose.
7. Cleanse child’s thigh or buttocks with alcohol swab and dry with gauze wipe. Squeeze thigh or buttocks and insert needle like a dart, draw back on the plunger to check for blood and if no blood is visible inject evenly, then pull straight out and wipe with gauze.