Hydrocortisone Emergency Kit

After my daughter was diagnosed with adrenal insufficiency, we had several meetings with her pediatric endocrinologist who tried to prepare us for the eventual possibility of an adrenal crisis. We were told the important signs to look for and given the Solu-Cortef injection, aka "the shot".  While I searched for an appropriate container for the shot and associated paraphenalia needed for our emergency kit, my husband acted out the scene from Pulp Fiction where John Travolta's character jabs Uma Thurman's character in the chest with an adrenaline shot. As I systematically emptied drawers looking for a small Rubbermaid container- he rummaged through the desk for a purple sharpie marker. I finally found a not yet used pencil box that fit the Solu-cortef vial, into which he tossed  a black sharpie mentioning that maybe we could get a purple one next time we were at Walmart. Needless to say, the sharpie was removed. It is not needed in the emergency kit. Unless you want to write, Emergency Hydrocortisone Kit on the outside of the container. I did.

Then I spent more days than I care to admit, stressing about the shot. What if I have to give it to her? How do I know when? What if I do it wrong? In my search for the answers, I felt more comfortable as I gathered supplies prepared for the situation. I packed an emergency kit, I familiarized myself with the procedure and most importantly the symptoms leading up to an adrenal crisis.


SIGNS OF ADRENAL CRISIS:
Usually there are signs before an adrenal crisis strikes. Knowing what signs to look for and having an emergency kit on hand at all times are 2 important steps to dealing with an adrenal crisis when it happens.

SYMPTOMS:

• sudden, penetrating pain in the lower back, abdomen, or legs
• severe vomiting and diarrhea
• dehydration
• low blood pressure
• loss of consciousness

The most common symptoms of adrenal insufficiency are chronic, worsening fatigue; muscle weakness; loss of appetite; and weight loss. I watch for complaints of headache, nausea and tummy aches, diarrhea, dizziness or confusion. These are flag symptoms for me that something is not quite right. If I notice these in my daughter, I pay close attention to her and keep the emergency kit handy. A lot of times, stress dosing can help prevent adrenal crisis. But sometimes, despite precautions- sicknesses, injuries, and stress can lead to an acute adrenal crisis.

It also occurred to me that all of the symptoms that indicate adrenal crisis could also be attributed to the flu or other illnesses. How do I know? Since illnesses can exacerbate the symptoms of adrenal insufficiency, I decided my best bet was to pay close attention to my daughter's moods and physical health. It helped when her endocrinologist told me that we could not overdose with Hydrocortisone and from there I adopted a better safe than sorry attitude. Adrenal Crisis can be fatal, it helped to know that I wouldn't harm her further by giving her extra Hydrocortison if necessary. If at any time there is severe vomiting, more than two times in an hour- or a loss of consciousness, the injection should be given.

WHAT'S IN MY EMERGENCY KIT:

Hydrocortisone Pills
Solu-cortef Vial (prescribed by a physician)
Needle(sterile)
Syringe(sterile)
Hand Sanitizing Wipes
Alcohol Wipes
Gauze Pads
Bandaids

Emergency Letter from Physician- This letter has my daughter's condition, how to treat it in an emergency and her physician's contact information. It is important for travelling with the injection and security checkpoints.

I use a small pencil box, some people use a first aid kit, zipper pouch,  or a tupperware container. The container is less important than the contents and it's most important that it's a size that is portable and easy to carry. I carry extra pill form Hydrocortisone(marked H, because she is also on Fludrocortisone) for days that we are out and about. I try and check my supplies every month or two as the pills and band-aids seem to get used up on a regular basis. I also double check to make sure the vial has not expired (they usually have a couple year life span) and that none of the sterile packages have been ripped open. If they have, I replace them.

Resources:
http://endocrine.niddk.nih.gov/pubs/addison/addison.htm


Adrenal Crisis as defined by the NIH
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001397