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Emergency Stress Dose for Central Adrenal Insufficiency

In patients with adrenal insufficiency, some conditions are medical emergencies. The patient may be too sick to take medicine by mouth.

More severe symptoms can be a life-threatening emergency. This is known as an adrenal crisis.

If you see symptoms of an adrenal crisis, give a shot (injection) of an emergency stress dose, and get medical help right away. Symptoms of an adrenal crisis include:

  • Low blood pressure
  • Low blood sugar (known as hypoglycemia)
  • Feeling faint or passing out (unconscious)

Always follow the instructions given by your care team. Patients with adrenal insufficiency should consider wearing a medical alert identification. This ID will alert first responders to their medical condition in an emergency.

Supplies needed

We suggest that you create a kit of supplies to keep with your child if they need an emergency stress dose. Prepare the kit before your child has an adrenal crisis. This will help you respond quickly. The kit should contain:

  • Solu-Cortef Act-O-Vial®
  • Syringe and Needle with safety cover (may come attached to the syringe)
  • Alcohol prep pads
  • Sterile bandage or gauze pad

You will also need to dispose of the needle and syringe in a sharps container after you have used it for the injection.

You must seek emergency medical attention after giving the stress dose.

How to give an emergency stress dose (injection) with a Solu-Cortef Act-O-Vial®

Clean the work area and wash your hands

  1. Clean the work area with disinfecting wipes or soap and water.
  2. Place your supplies on the work area you just cleaned.
  3. Wash your hands with soap and water for at least 20 seconds or use hand sanitizer and rub until your hands are completely dry. This is an important step to help prevent infections. See Handwashing.

Prepare the syringe

Use your prescribed emergency stress dose of hydrocortisone from the Solu-Cortef Act-O-Vial®. To prepare the dose:

  1. Push the plunger of the Solu-Cortef Act-O-Vial® vial down firmly to mix the medicine.
  2. Mix the medicine by turning the vial upside down several times until the liquid is clear and all the medicine is dissolved.
  3. Remove the yellow tab on top of the vial to expose the orange stopper.
  4. Clean the vial top with an alcohol wipe.
  5. Remove the cover from the syringe.
  6. Pick up the vial and turn it upside down.
  7. Insert the syringe into the orange stopper.
  8. Fill the syringe with the prescribed dose of medicine. You may have to tap the syringe slightly to remove any air bubbles.
  9. Put the cap back on the syringe and lay it on a clean surface.
Illustration of someone giving an intramuscular injection showing the angle at 90 degrees to the skin and showing the layers of skin including subcutaneous tissue and muscle.

Give intramuscular injections into the thigh at a 90-degree angle (straight up and down).

Give the emergency stress dose by intramuscular injection into the thigh

  1. Expose the skin of the thigh if possible. If not possible, you may need to inject through the clothing.
  2. Using a new alcohol pad, clean the injection site on the thigh for 8 seconds. In an emergency, if you do not have an alcohol pad, then give the dose anyway.
  3. Pick up the syringe and pull the cap straight off (do not twist). Set the cap aside. If there is a safety cover, pull back on the cover toward the syringe.
  4. Hold the syringe between the thumb and first finger.
  5. Using the other hand, stretch the skin on the thigh so that it is slightly tight. If your child is thin, pinch the tissue between your thumb and index finger. Do not touch the clean injection site itself.
  6. Insert the needle at a 90-degree angle (straight up and down) into the injection site.
  7. Release the skin.
  8. Gently push on the plunger until you have injected all of the medicine.
  9. When all the medicine is given, remove the needle from the skin at the same angle it went in. Throw out the needle and syringe in a sharps container.
  10. Seek emergency medical treatment. Call 911 or go to the nearest emergency room after giving the emergency stress dose.
 

Safety reminders for the emergency stress dose

  • Your child should always carry an emergency dose of hydrocortisone and their emergency kit with them.
  • Caregivers should be able to recognize more severe symptoms of an adrenal crisis and know how to give an emergency stress injection if needed.
  • After giving an emergency stress dose, call 911 or go to the nearest emergency room.

Key points about the emergency stress dose

  • For patients with central adrenal insufficiency, some conditions are medical emergencies and may require an emergency stress dose.
  • Patients with central adrenal insufficiency should always carry a Solu-Cortef Act-O-Vial® and an emergency kit with them.
  • If you see the symptoms of an adrenal crisis, give a shot (injection) of an emergency stress dose, and get medical help right away.

—
Reviewed: August 2023

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