The Emergency Injection for the treatment of Adrenal Crisis Understanding what an Emergency Injection kit is, how to inject and how important it is to use the injection during an Adrenal Crisis. Get an emergency injection kit - it may save your life After diagnosis, you should be issued with a prescription for the medication required for a hydrocortisone emergency injection kit. This will include vials of hydrocortisone that either you or a friend or family member can administer if you are vomiting and unable to absorb oral tablets, or showing other signs of severe illness. Your GP or endocrinology team can prescribe the items required for the kit. There are two types of hydrocortisone available. These are prescribed as 3 – 5 vials. You will be prescribed either: Hydrocortisone sodium phosphate 100mg (1ml liquid ampoule), or Hydrocortisone sodium succinate 100mg (powdered Solu-Cortef plus 2ml water amp.) You will also need the necessary intramuscular needles and syringes needed to inject. Alternatively, Vanishpoint integrated safety syringes are available from our charity online shop or you can store your emergency kit in a way convenient for you. More information on the items to be prescribed can be found in the 'medication management' section of The ADSHG Caring For the Addison's Patient leaflet. Many people prefer hydrocortisone sodium phosphate (ex-Efcortesol) for their injection kits as this requires no mixing, before drawing up into the needle for injection. However if this is unavailable you should swap temporarily to Solu-Cortef which is a dried form of hydrocortisone that is mixed with a water vial before injection. The 'How-To' leaflets for your kit and instructions below cover both types of hydrocortisone medication for injection. Read our article 'Drug shortage causes and coping strategies' for more information. When to give an emergency injection You can read more about the symptoms of adrenal crisis and what you should do in the emergency section of our website. Learn how to administer an emergency injection - practise makes perfect! Once you have your kit, both you and people that you spend a lot of time with, such as family, colleagues or friends, should learn what to do if you have an adrenal crisis and how to give an emergency injection of hydrocortisone. Learning how to do this is very important. It doesn’t take very long and it could save your life. Regularly check your kit to make sure the vials are in date, requesting replacements for any out of date vials. Check out these short videos : Video : 1. When to give an emergency injection (4 minutes) Video : 2. Emergency injections: Personal stories (5 minutes) Video : 3.1 How to administer a liquid hydrocortisone emergency injection using a safety syringe (3 minutes) Video : 3.2 How to administer a liquid hydrocortisone emergency injection using a standard syringe (3 minutes) Video : 3.3 How to administer a Solu-Cortef emergency injection using a safety syringe (3 minutes) Video : 3.4 How to administer a Solu-Cortef emergency injection using a standard syringe (3 minutes) Video : 3.5 How to administer a Solu-Cortef emergency injection using an Act-o-Vial Safety Syringe (3 minutes) Print out our emergency injection leaflets to keep in your kit Download our emergency injection leaflets #ShareYourKit Help normalise this potentially scary situation by using our #ShareYourKit when posting a picture of your kit on Instagram or Twitter, or send your examples direct to the ADSHG! We love to see how you store your injection kit and raise awareness, just like Craig below. You can also search the hashtag to see other peoples kits or take a look on our blog. Visit our #ShareYourKit blog to see more examples What to do if you are refused an injection kit People with Addison's require an emergency injection kit (100mg hydrocortisone) for at home, when travelling and on holiday, for use in an emergency to avoid precipitating an acute adrenal crisis. This is so either you or a friend or family member can immediately administer if you are vomiting and unable to absorb oral tablets, or showing other signs of severe illness. Therefore if there is a delay in getting an ambulance to you or in a busy hospital A&E department, the hydrocortisone injection means that you will be safe from the adrenal point of view until you receive further medical attention. Provision of a hydrocortisone emergency injection kit is standard practice and is the advice given by the ADSHG Clinical Advisory Panel and Society for Endocrinology, for the prevention of an acute adrenal crisis. Here is some guidance on the next steps you can take: Write or Email: If your GP or Endocrinologist does not wish to provide additional prescriptions to provide the above cover, please direct them to our "Why should I give my Adrenal Insufficiency Patient an Emergency Injection Kit?" page. This provides them with the latest Clinical Guidance and advice that a kit is necessary. Ask them to read the page and then politely request again that an injection kit is prescribed. Include medical evidence: It is helpful to include copies of Clinical Guidance and research which confirms that prescribing an emergency injection kit is standard practice for your GP or Endocrinologist, along with your letter/email/request. Clinical Guidance: The advice from the Society for Endocrinologists for people with adrenal insufficiency. Research: Guidance for the prevention and emergency management of adult patients with adrenal insufficiency Further research with quotes highlighted are included on our "Why should I give my adrenal insufficiency patient an emergency injection kit?" page. Please scroll to the 'Clinical Guidance' section. Clinical Guidance for Healthcare Professionals regarding Injection Kits Due to Addison's and adrenal insufficiency being a rare disease, medical professionals don't always have the information they need to make certain decisions. With over 7,000 rare diseases, it isn't possible for your GP to be an expert on your condition. Providing them with this information and working with them, means they have the medical evidence they need to prescribe an injection kit. Elements to include in kit: If they are unsure about the elements to prescribe, we list these in our The ADSHG Caring For the Addison's Patient leaflet. Please provide your GP with a copy. Injection Training: If they are unable to provide injection training, you can reassure them you will learn via the print out injection instruction leaflets available on the ADSHG charity website along with training videos demonstrated by an endocrine specialist nurse. Next steps inc PALs: After sending this email/letter, if your endocrinologist or GP still refuse - ask them to answer why they are going against the expert advice and guidance of the Addison's Clinical Advisory Panel (CAP). This is so you have their response in writing and helps provide clarity. Let your GP know it is your intention to include their answer when writing formally to PALs about their unsafe management of your Addison’s or adrenal insufficiency. If they still refuse and you are UK or ROI based, please also provide details of this refusal to us and we will ensure that the surgery or endocrine unit receive some of our advice and materials ls to help raise awareness. How to store your injection kit Some hospital endocrine units provide ready made injection kits for you. If this is not the case for your hospital, in our online shop, we sell emergency injection boxes (minus the drug preparations which your GP or Endocrinologist needs to prescribe). These come with amp snaps (for the glass vial) along with photo instructions on how to give the injection and allow you to keep all the materials needed to give the injection in the same place. Alternatively, you can choose a small sturdy box yourself to keep your emergency kit in. Ensure the box is clearly labelled. It is advisable to include the photo instructions on how to give the injection, adrenal crisis guidelines, hospital stickers and NHS steroid emergency card in the box. See our more detailed advice on preparing your own emergency kit. #ShareYourKit - search our hashtag #ShareYourKit to see other peoples kits on Instagram or Twitter, take a look on our blog or send your examples direct to the ADSHG! We love to see how you store your injection kit and raise awareness. Whether you're newly diagnosed or have lived with the condition for years - please join our community and support our cause! You'll receive the latest expert advice, guidance and ADSHG news, whilst being part of our inspiring and supportive community. Become a member today! Join the ADSHG Say hello! Follow us on Twitter, Facebook, Instagram, LinkedIn and YouTube.