A person's body usually makes hydrocortisone-like hormones, called steroids, which are needed for good health. These steroids are chemicals that play an important role in the way the body uses sugars, fats, and proteins. They are also important in the body's fight against the stress of illness. If the body does not produce enough of these steroids, the doctor may prescribe a medicine called hydrocortisone (HY-dro KOR-ti-zone). This medicine can usually be taken by mouth.
Hydrocortisone will need to be given by injection when your child is unable to take their dose by mouth because of vomiting or when they need more during times of stress. Hydrocortisone is a safe medicine with few side effects when taken in the amount prescribed by the doctor.
When to Give More Hydrocortisone
Your child will need an increased amount of hydrocortisone at these times:
- Infection or fever of 101F or higher
- Diarrhea more than twice on the same day
- Non-routine dental procedures
- Throwing up (vomiting) more than twice on the same day
- Severe sprain, strain, fracture
- Other situations of stress as directed by your doctor
Steps to Follow
When your child needs an increased amount of hydrocortisone, follow these steps:
- First, try to give your child the prescribed stress dose by mouth.
- If your child vomits within 15 minutes after taking the dose by mouth, they did not get the medicine. Give it one more time. If they vomit again within 15 minutes give the injection.
- If your child is too ill or so badly injured that the stress dose cannot be taken by mouth, give the injection.
- After giving the injection, call your child’s doctor to explain how they are doing and what medicine was given. The doctor will give you further instructions.
You Will Need
- Vial of medicine (Two-compartment Act-o-Vial®)
- Bottle of rubbing alcohol
- Disposable syringe with needle
- Puncture-resistant container for syringe disposal
- Cotton balls or dry tissue
Preparing Hydrocortisone for Injection
1. Wash your hands.
4. Gently shake the solution until it is clear.
5. Remove the plastic disk from the top of the protective cap.
6. Clean the rubber stopper with a cotton ball dipped in alcohol or an alcohol swab.
7. Place the needle through the center of the plunger-stopper until the tip is just visible inside the bottle.
8. Hold the vial upside down and draw your child’s hydrocortisone dose into the syringe.
Leave the syringe in the vial and tap the syringe gently to make air bubbles rise. Gently push the plunger to force air bubbles out of the syringe. Check the syringe to make sure the dosage is correct. Leave the needle and syringe in the vial until you are ready to give the dose.
Choosing the Injection Site
The site for the injection should be halfway between the hip bone and knee on the outer part of the thigh. This area is chosen because it is free of large blood vessels and nerves. This site can be used for a child of any age.
Giving the Hydrocortisone Injection
Infants and Toddlers – Hold your child firmly between your elbow and body. Make sure you have complete control of their leg movements. You may also swaddle your child, leaving the injection site exposed.
Older Children – Explain what you are going to do and why. If possible, have your child lie on their side and turn their foot inward to relax the thigh muscles.
1. Clean the skin at the injection site with an alcohol-moistened cotton ball or alcohol swab and let air dry. Stretch skin on outer thigh tight. Hold the syringe like a pencil. Slip the needle in quickly at a 90 degree angle (straight up and down).
2. Slowly push the plunger all the way in.
3.After all the medicine is given, remove the needle and release the skin. Dispose of the used needle and syringe (see below).
4. Put a Band-Aid® on the site if needed.
Disposing of the Used Needle and Syringe
Do not recap the needle. Do not touch the needle. Do not bend or break off the needle. Do not remove the needle from the syringe.
- Drop the used syringe and needle into a sharps container or a hard plastic or metal container with a screw-on or tightly secured lid. An empty plastic bleach bottle or liquid laundry soap container may be used. If a coffee can is used, first reinforce the plastic lid with heavy-duty cloth tape. Do not use glass or clear plastic containers, such as milk cartons.
- Do not put needles in a container that will be recycled or returned to a store.
- Do not let the container get too full. When the container is almost full, tape down the cover or lid, and put it into a bag. Check with your fire station or health department to see where local sharps containers can be taken for disposal. The last option is to wrap the container in duct tape and dispose in the trash. Call your trash removal company if you have any questions.
CAUTION: Syringes and needles should be used only once.
- CAUTION: Store all supplies in a dry place, out of the reach of children and others who might misuse them.
- Light and moisture make this medicine not work as well. Store it in a dark, dry place (not in the bathroom or above the kitchen sink).
- Keep this medicine away from heat or direct sunlight.
- If your child’s dose of hydrocortisone is not the full vial (100mg), throw away the remaining medicine in the vial. The vial can only be punctured one time with a needle and syringe.
- Once the hydrocortisone powder is mixed with the liquid, it is only good for 3 days. If your child does not use the dose right away, store the mixed vial in the refrigerator for 3 days.
- Once the hydrocortisone powder is mixed with the liquid but not punctured, it is only good for 3 days. If your child does not use the dose right away, store the mixed vial at room temperature for up to 3 days.
- Check the expiration date on the hydrocortisone vial every month.
- If the hydrocortisone is outdated, take to a drug take-back location. You may also mix the leftover medicine with an unwanted material like coffee grounds, and place the mixture into a container or a bag that will not leak. Throw the container away in the trash where children and pets cannot reach it.
- If you have questions, please ask your doctor or nurse or call ____________________.
HH-V-86, 1/93, Revised 08/19 | Copyright 1993, Nationwide Children’s Hospital