- Reference Number: HEY-873/2017
- Departments: Paediatrics
- Last Updated: 6 March 2017
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This leaflet has been produced to give you general information with regards your child’s steroid deficiency. Your child is unable to produce sufficient cortisol and therefore needs steroid replacement treatment. Cortisol is a hormone produced by the adrenal glands and is essential for day to day life. It is one of the major hormones that enables the body to deal with the stress of illness.
There are a number of reasons why your child maybe deficient in cortisol and the specific treatment will depend on the cause. You will have been told of the exact cause in your child’s case but certain important principles apply to all who are on steroid replacement treatment.
Your child is unable to produce sufficient cortisol and requires replacement Treatment because he/she has:
…………………………………………………………………………………………………………………………..
A child on steroid replacement treatment MUST have the treatment given accurately and regularly according to the instructions given to you
THEIR LIFE AND HEALTH DEPEND ON THIS REGULAR TREATMENT.
Children on steroid replacement require replacement treatment cannot naturally increase their steroid level in response to stress, as would normally occur in illness. Therefore in any significant illness the dose of steroid must be increase.
See table below:
| Illness | Hydrocortisone Dose | Duration |
| Cold, runny nose, cough otherwise well | No increase necessary. | N/A |
| Moderate to severe illness, high temperature above 37.5oc | Double the highest dose and give every 6 hours until temperature back to between 36-37oC. | For 2 -3 days if no improvement contact your GP. If antibiotics prescribed, continue hydrocortisone 6 hourly until course of antibiotics completed. |
| Vomiting | Double the highest dose and give every 6 hours. If they are unable to tolerate oral hydrocortisone and continue to vomit, the emergency hydrocortisone injection is required | Call an emergency ambulance crew to administer the injection or administer the injection yourself and call the ambulance to take your child straight to children’s emergency department for assessment and treatment |
| Diarrhoea | 1) Double the highest dose and give every 6 hours whilst diarrhoea persists 2) If diarrhoea is accompanied by vomiting, Emergency injection required |
1) If no improvement in 48 hours contact your G.P.
2) If emergency injection required contact the emergency ambulance service to administer hydrocortisone injection or administer it yourself, go straight to the children’s Emergency department for assessment via ambulance |
| Immunisations | Double the highest dose and give every 6 hours for 24 hours on the day of injection. | For 24 hours on the day of injection. |
| Dental treatment
1) Check-up or cleaning 2) filling 3) extractions
|
1) No increase required 2) Double the highest dose and give every 6 hours on the day of the appointment 3) Dentist to contact consultants to discuss hydrocortisone cover. Please ensure your dentist is aware your child is on hydrocortisone before any procedures performed |
1) No increase required
2) For 2-3 days 3) As per consultants discussion. (Usually 2-3 days)
|
| Planned Surgery Endocrine team to liaise with surgical team prior to surgery to ensure adequate hydrocortisone cover. |
Children under 5
1) IV 50mgs hydrocortisone 2) IV 50mgs hydrocortisone 3) followed by doubling highest dose of oral hydrocortisone Children over 5 1) IV 100mgs hydrocortisone 2) IV 100mgs hydrocortisone 3) followed by doubling highest dose of oral hydrocortisone |
Children under 5
1) on induction 2) 4 hours post op 3) give every 6 hours for 48 hours Children over 5 1) on induction 2) 4 hours post op 3) Give every 6 hours for 48 hours |
| Accident, injury or shock. Serious injuries, burns, breaking of limbs, head injury, loss of consciousness | Give the emergency hydrocortisone injection and call the emergency ambulance service. Your child will be taken straight to children’s accident and emergency department for assessment | Please consult with Paediatric Endocrine Consultants in relation to the child’s management. |
Emergency Admission Guidelines for Hospital Staff:
This child is on replacement steroids and is at risk of adrenal crisis if not treated quickly. If this patient is brought to hospital as an emergency admission we advise the following management.
Blood tests for sodium, potassium, chloride, bicarbonate, urea, glucose, creatinine, calcium, and cortisol are obtained.
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Please administer Hydrocortisone injection if not already been given by parents or paramedics. (may require further bolus doses)
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Commence IV fluids as 0.9 sodium chloride and 5% glucose at maintenance rate
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Monitor blood pressure.
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Contact the paediatric endocrine consultant via switch board in relation to their patient’s management.
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Ensure the child stays for a minimum of between 10 to 12 hours before discharge home
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If the child is on DDAVP and is ill enough to require an injection of hydrocortisone, STOP DDAVP AND SEEK MEDICAL ATTENTION. Allow the child to drink freely to satisfy thirst. Ensure plasma and urine sodium and osmolality along with strict fluid balance chart are monitored during the admission.
Information for the Parents or Carers
If your child seems very unwell, particularly if they are pale, clammy or not responding normally and/or seeming drowsy, the injection of hydrocortisone must be given at home, call the ambulance service and get them to hospital as soon as possible. No harm can come from injecting the Hydrocortisone unnecessarily and their life/health may depend on it if they look extremely unwell.
You will have been given the hydrocortisone and shown how to inject it at the hospital. You will need to make sure the injection you have at home stays ‘in date’ and get a further supply from your GP as it reaches the expiry date.
The dose of the injection is 25 mg for babies, 50 mg for children aged 1-5 years and 100 mg for older children (your child will not come to harm if you accidentally give a bigger or smaller dose). The dose is given as an intramuscular injection into the outside of the thigh mid-way between the hip and knee – there are no important structures to hit with the needle at this site. Insert the needle to its full depth and inject the correct dose.
The child should be assessed in Emergency Department immediately after being given an intramuscular hydrocortisone injection. It is very likely that he/she may need a further period of observation (generally a minimum of 8-12 hours to ensure adequate fluid intake and stable observations including a blood pressure and blood glucose measurement before being discharged home.
In case of emergencies for when you are not with your child, or in case of an accident it is strongly advised that your child wears some form of identity bracelet / necklace, stating your child is steroid deficient and is on replacement treatment.
