Why do people with adrenal insufficiency need an emergency injection kit?
Each year, typically 32% of people with adrenal insufficiency experience a life-threatening adrenal crisis requiring a time-critical emergency injection of intramuscular hydrocortisone.
An adrenal crisis can happen anywhere. At work. Out shopping. On holiday. When exercising, particularly if the sport is in a remote location such as a hill walk. If an ambulance crew is delayed in arriving to help a patient, or the patient is unable to get to a medical facility for any other reason, an injection kit could save their life.
Patient story: injection kit saves lives
Who should provide an injection kit?
The NICE guidance includes that a minimum of two emergency injection kits should be prescribed so that spares are available for travel or in case a vial shatters and becomes unusable in an adrenal crisis.
Endocrine healthcare teams are best placed to provide the initial injection kit supplies, and emergency hydrocortisone prescription for the GP to fulfil on an ongoing basis as required.
What do you need to provide in a kit?
In our experience, this varies from NHS Trust to NHS Trust though the core 'ingredients', as referenced by the NICE Guidelines in section 1.3.10 need to include:
- hydrocortisone sodium succinate 100 mg powder and 5 ml or 10 ml water for injection (1 vial)
- two blue needles
- two 2 ml syringes
- written instructions in an easy-to-understand format (for example, with diagrams or pictures) on how to prepare and give emergency intramuscular hydrocortisone and how to safely dispose of needles and syringes
- steroid emergency card
What training is needed on how to use the kit?
Training on how to draw up an emergency injection of hydrocortisone should be given when the kit is provided. Training should be for the patient and also close carers/partners who may be required to administer the injection in an emergency.
Patients with established AI and their carers/family members should be educated about the risks of intercurrent illness, trained in (self) administration of 100 mg im hydrocortisone (efcortisol or solucortef) and told that if the vomiting and diarrhoeal illness persists they should attend their local hospital, as they will need parenteral hydrocortisone and intravenous fluids without delay. Patients and their relatives or carers can be taught how to self-inject by their endocrine clinical nurse specialist.
Simpson H, Tomlinson J, Wass J, Dean J, Arlt W. Guidance for the prevention and emergency management of adult patients with adrenal insufficiency. Clin Med (Lond). 2020 Jul;20(4):371-378. DOI: 10.7861/clinmed.2019-0324 PMID: 32675141; PMCID: PMC7385786.
ADSHG resources to support training
The ADSHG can provide the following resources:
- step-by-step instruction leaflets
- training video (see below)
- injection training kits for 'at home' practice.
