Hydrocortisone (IV — Paediatric Emergency)

How it works

A glucocorticoid that binds intracellular corticosteroid receptors to modulate gene transcription, producing broad anti-inflammatory and immunosuppressive effects and, in deficiency, restoring physiological cortisol activity.

Prescribing in practice

• In suspected adrenal crisis, parenteral hydrocortisone must be given without delay and not withheld pending investigations, as untreated crisis is rapidly life-threatening.
• It is an adjunct in anaphylaxis and acute severe asthma and must never replace adrenaline or oxygen and bronchodilators as first-line treatment.
• Confirm emergency paediatric dosing by age against local resuscitation guidance and a children's formulary.

Monitoring

Monitor blood glucose, blood pressure, fluid balance and electrolytes during emergency treatment and arrange appropriate follow-up of the underlying cause.

Counselling the patient

• Ensure families of children with adrenal insufficiency know the sick-day rules and emergency injection plan.
• Advise carrying a steroid emergency card or alert where adrenal insufficiency is known.
• Explain that emergency steroid is being given to support the child's stress response.

Evidence & guidelines

Parenteral hydrocortisone is standard emergency management of adrenal crisis and an established adjunct in anaphylaxis and acute asthma per resuscitation and endocrine guidance.