What Should Be in My CAH Emergency Injection Kit? Checklist

An emergency injection kit for Congenital Adrenal Hyperplasia (CAH) must contain an unexpired vial of injectable hydrocortisone (including its sterile diluent), properly sized syringes and needles, alcohol swabs, a written emergency action plan with a pre-calculated dose, and a medical alert card. Having these items immediately available at all times is a critical preparedness measure, as they provide a life-saving bridge to emergency medical care during an adrenal crisis ^[1][2].

🚨 In a Medical Emergency

An emergency injection of hydrocortisone is required when a patient with CAH cannot absorb their oral medication (due to severe or repeated vomiting, diarrhea, or an inability to swallow) or when the body experiences severe trauma, major surgery, or unresponsiveness ^[3].

If these triggers occur:

1. Inject without delay: Follow your written plan to give the prescribed injection immediately. Do not attempt to calculate a dose during an emergency; use the pre-calculated dose provided by your doctor.
2. Call Emergency Services: An injection is a bridge to care, not a replacement. Seek immediate medical assessment, even if the person seems to improve. Tell first responders that the patient has CAH/adrenal insufficiency.
3. Bring the Kit: Bring the empty vials, your written emergency plan, and any remaining supplies with you to the hospital.

Understanding Key Terms

• Adrenal Crisis: A life-threatening emergency where the body does not have enough cortisol to maintain blood pressure, blood sugar, and basic functions.
• Stress Dosing: Temporarily increasing the dose of hydrocortisone during illness or physical stress to mimic how a healthy body would respond.
• Diluent: The sterile liquid used to mix and dissolve the powdered medication so it can be injected.
• Intramuscular (IM): An injection given deep into a muscle, which is the standard route for emergency hydrocortisone at home.

Essential Kit Contents

To ensure you or your child are prepared, your emergency kit should include:

• Injectable Hydrocortisone and Diluent: This is typically prescribed as hydrocortisone sodium succinate (e.g., Solu-Cortef). The kit must include both the powdered medication and the sterile liquid (diluent) to mix it. Some products, like the Act-O-Vial, contain both the powder and the diluent in a single device separated by a stopper ^[1].
• Syringes and Needles: Your doctor will prescribe specific syringes and needles. The prescription will depend on the injection route (usually intramuscular), the injection site (such as the thigh), and the patient’s body size. You may need separate, larger needles to draw up the medication and smaller ones to inject it.
• Alcohol Swabs: For cleaning the skin at the injection site and wiping the rubber top of the medication vial.
• Emergency Action Plan: A written plan from your endocrinology team. It must state exactly when to inject, the pre-calculated dose and volume, and the injection route ^[3].
• Medical Alert Card: A physical card (and ideally a medical alert bracelet) stating the patient has CAH/adrenal insufficiency, requires urgent emergency hydrocortisone, and listing the treating clinician and emergency contacts ^[1][4].

Maintenance and Storage

An emergency kit is only helpful if the supplies are ready to use.

• Routine Checks: Check expiration dates on all supplies frequently (such as every 3 to 6 months). Confirm that needles remain in their sealed, sterile packaging and that alcohol swabs have not dried out.
• Proper Storage: Follow the exact product label for storage. Unmixed powder and diluent generally must be protected from freezing, excessive heat, and direct light ^[2]. Do not store the kit in a hot car.
• Do Not Pre-Mix: Never mix the powder and liquid ahead of time. Once mixed (reconstituted), the hydrocortisone must be used immediately, and any unused portion should be safely discarded according to your pharmacist’s instructions.
• Backup Kits: Consider keeping fully stocked backup kits at school, daycare, or work so they are always accessible. Provide a copy of the emergency action plan with each kit.

Training and Preparation

Simply carrying a kit does not make you prepared; patients and caregivers must be confident in how to use it. Detailed instruction from a clinician significantly improves a caregiver’s ability to manage an adrenal crisis ^[5].

• Repeated Practice: Repeated teaching is essential ^[6]. Ask your care team for a hands-on demonstration using a practice vial or trainer device. Never practice with active medication or unsupervised needles, which could cause injury or contamination.
• Train All Caregivers: Ensure that partners, grandparents, teachers, and babysitters know where the kit is and how to follow the emergency plan.