Emergency Hydrocortisone Injection

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When is a hydrocortisone injection required?

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

An injection of hydrocortisone is essential in these circumstances.

Who should give the injection?

Your GP or practice nurse, or hospital nurse / doctor Accident and Emergency department
A person who has been trained to give this injection and assessed by a health professional to do this safely

You should not attempt the injection if you have not received training to do this from a health professional.

After the injection has been given

If your symptoms continue, you will require a further injection of hydrocortisone to maintain the cortisol levels.

It is essential, if you have given your injection yourself, or from a person who is not a health professional that you contact your doctor to inform them you have given the injection, and that you need to be seen by them as soon as possible.

Should you find difficulty contacting your local doctor for an injection of hydrocortisone, then it is important you attend your local Accident and Emergency department to receive the injection.

Training to give the injection

This information explains how to give the emergency hydrocortisone injection.

The endocrine nurse specialist is available to teach you or a designated person how to give an emergency hydrocortisone injection. You should not attempt this injection if you have not been trained to do it. Contact your GP to give you the injection.

This information should be read together with information on: Steroid replacement treatment.

Travelling abroad

You are required to carry a letter from your GP or hospital stating you are carrying hydrocortisone and needles for a medical condition. You should inform staff at check-in that this is required to be carried in your hand luggage, not in baggage. The staff may take this from you whilst in transit and return it to you when you land.

Storage of injection

Store the hydrocortisone emergency pack in a sealed container. The ampoule of hydrocortisone and water has a date on it that informs you when it expires (exp). Contact your GP to replace this when it has expired. Further supplies of hydrocortisone can be obtained from your GP.

Hydrocortisone injection steps

Collect equipment

Hydrocortisone ampoule
Water for injection
Green needle
Blue needle
Syringe
Cotton wool ball
Sharps disposal bin

Remove the cap from hydrocortisone ampoule

Remove cap from water using a twisting action
Attach the green needle to the syringe

Insert the syringe with the needle attached into the water for injection

The end tip of the needle needs to be below the water.
Pull the syringe plunger back to pull the water into the syringe. Continue until there is water in the syringe to between the 1 and 2 marked on the syringe.
Remove the needle and syringe from the water.

Hold the ampoule of hydrocortisone firmly in one hand

Push the needle attached to the syringe into the ampoule through the centre of the rubber bung.
Gently push the plunger of the syringe to push the water into the ampoule.
Pull the tip of the needle back until it is above the water level in the ampoule. Gently pull the plunger back to between the 1 to 2 mark. There should not be any fluid in the syringe now.
Take the needle out of the ampoule.
Gently shake the ampoule until the powder and water is mixed

Pull the syringe plunger back to between 1 to 2. Hold the ampoule of hydrocortisone upside down and push the needle into the ampoule to just after the rubber bung

Pull the plunger back to withdraw the fluid from the ampoule then remove the needle from the ampoule.

Hold the needle and syringe upright and push the plunger gently to expel any air in the syringe. You should see a drop of fluid at the top of the needle.

Change the needle on the syringe to a blue needle.

Remove clothing from site of injection. The site is the outer part of the thigh, this is seen on the diagram below.

Hold the syringe and needle at a 90° angle to the skin.

Push the needle into the skin to the end of the needle.

Pull the plunger back gently and check there is not any blood in the syringe. If there is, withdraw the needle and start again.

Push the plunger in gently to inject the fluid.

Inject all the solution and withdraw the needle and syringe, there may be a small drop of blood. If so, press on the site for a short time with a piece of cotton wool.