Department of Child Health
Salisbury NHS Foundation Trust
Salisbury District Hospital
Salisbury
Wiltshire
SP2 8BJ
Telephone: 01722 336262
Ext. 2560/4201
Name
DoB
Date
Diagnosis
…………………………………………………………………
IF UNWELL AND ADMITTED TO HOSPITAL THIS PATIENT MUST RECEIVE
INTRAVENOUS OR INTRAMUSCULAR HYDROCORTISONE WITHOUT DELAY
This child is under shared care
Tertiary Care Local Care
Dr Carl Taylor,
Consultant Paediatrician
Address above
Dr Justin Davies , Consultant Paediatric
Endocrinologist
Dr Nikki Davis , Consultant Paediatric
Endocrinologist
Paediatric Medicine, Mailpoint 43
Southampton General Hospital
Tremona Road
Southampton
SO16 6YD
Telephone: 023 8079 6985
Fax: 023 8079 5230
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It is essential patients with adrenal insufficiency carry emergency injections of efcortesol hydrocortisone with them at all times including air travel
This patient has adrenal insufficiency and is taking hydrocortisone to maintain good health and growth.

If the patient is able to take their hydrocortisone orally, their usual dose should be doubled until well

If a dose of hydrocortisone is vomited within 1 hour of administration, the dose should immediately be given again.

If they were to omit or not absorb the hydrocortisone (e.g. due to vomiting or diarrhoea) they are at high risk of developing an ‘Addisonian crisis’ i.e. low blood glucose, low sodium, high potassium, dehydration, low blood pressure and collapse. This is potentially life threatening. An emergency dose of efcortesol hydrocortisone should be given intramuscularly according to the following doses and repeated 6 hourly:-
0-1yr
1-5yrs
25mg
50mg
>5yrs 100mg
The family should then seek emergency medical assistance. These same doses can be used by admitting doctors.

Patients with ongoing significant illness e.g. D&V, febrile, infection, or patients who develop signs of under-treatment with hydrocortisone e.g. low sodium, high potassium, lethargy, low blood sugar, dehydration, low blood pressure, should continue to be given 6 hourly IV or IM hydrocortisone at the doses above.

The patient should be observed in hospital for 12-24 hours after emergency hydrocortisone to observe for further signs of adrenal insufficiency or intercurrent illness
Please inform the paediatric endocrine team of the admission or hospital review as soon as possible.
Yours sincerely
Dr Carl Taylor
Consultant Paediatrician
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