What Should Be in an Addison's Disease Emergency Kit?

An adrenal crisis emergency injection kit must contain a vial of injectable hydrocortisone (such as the Solu-Cortef Act-O-Vial), appropriately sized syringes and needles, alcohol swabs, and a set of personalized written instructions. This kit is a critical safety net that provides a high dose of steroids when the body cannot produce enough cortisol during serious illness or stress ^[1][2].

Having an emergency kit on hand is a strong medical recommendation for anyone with primary adrenal insufficiency (Addison’s disease), as well as many patients with secondary or tertiary adrenal insufficiency ^[3].

What to Include in Your Emergency Kit

When assembling your kit, ask your doctor and pharmacist for the following components:

• Injectable Hydrocortisone: The most commonly prescribed emergency medication for adults is hydrocortisone sodium succinate ^[4]. One frequently used presentation is the Solu-Cortef Act-O-Vial, which contains the powder and a preservative-free water diluent in a single vial that you mix by pressing down on the cap ^[5].
• Syringes and Needles: You will need needles suitable for an intramuscular (IM) injection. While a 22 to 25-gauge needle (1 to 1.5 inches long) is often used for adults, the exact size depends on your age, body size, and the injection site. Your pharmacist will provide the exact size best suited for your body type.
• Alcohol Swabs: To clean the injection site and the top of the vial before drawing the medication.
• Sharps Container: A safe, hard-sided container to dispose of the needle immediately after use.
• Written Adrenal Insufficiency Action Plan: Your kit must include clear, step-by-step instructions provided by your doctor. This plan should explain exactly when to inject the medication, your specific dose (usually 100 mg for adults, but pediatric doses are different and based on age or weight), and how to recognize the early signs of a crisis ^[6][7][8].
• Steroid Emergency Card and Medical ID: Include a medical alert card in the kit, and wear a medical-alert bracelet or necklace. It should state that you have adrenal insufficiency and require immediate steroid treatment ^[9][6].

When to Use the Kit

Do not wait for a drop in blood pressure or loss of consciousness to use your kit. Your personalized action plan should provide explicit triggers for the injection. Common triggers include:

• Persistent vomiting or diarrhea (inability to keep oral medication down)
• Severe injury or trauma
• Fainting, collapse, or extreme weakness
• Severe confusion or altered consciousness

The Importance of Caregiver Training

During an adrenal crisis, blood pressure drops rapidly, which can lead to severe confusion, weakness, or even loss of consciousness ^[10][4]. Because of these symptoms, many patients physically cannot give themselves the injection when they need it most ^[11][12].

Because the injection process involves multiple steps, it is crucial to train family members, close friends, or coworkers on how to use the kit ^[11][13]. Practicing the steps with a demonstration kit in your doctor’s office can help your loved ones feel confident acting quickly in an emergency ^[12][14].

Storing and Maintaining Your Kits

Your emergency kit will only save your life if it is accessible and the medication is effective.

• Carry a Backup Kit: You should never be far from your medication. Keep a primary kit with you at all times in a bag or purse, and store backup kits in key locations, such as your workplace or at home.
• Store at Room Temperature: Hydrocortisone vials must be kept at controlled room temperatures according to the manufacturer’s label. Do not store kits in a car, as vehicles can reach extreme heat or freezing temperatures that degrade the medication. Once the powder and liquid in an Act-O-Vial are mixed, the solution must be used promptly or discarded; do not store a mixed vial.
• Check Expiration Dates Regularly: Make it a habit to check the expiration dates on your hydrocortisone vials and syringes every few months. Inspect the vials to ensure the powder is dry and the liquid is clear. Set a calendar reminder to replace them before they expire.

Immediate Action: Call Emergency Services

The emergency injection is an early rescue measure, not a substitute for complete medical treatment ^[15][8].

• Call 911 / Emergency Services Immediately: If two people are present, one person should call emergency services while the other prepares and gives the injection. If you are alone, give yourself the injection and call immediately afterward. Do not attempt to drive yourself to the hospital.
• Do Not Delay the Injection: If you suspect a crisis, give the injection immediately. Do not wait for medical personnel to arrive before administering it ^[4][7].
• At the Hospital: Show the medical staff your steroid emergency card and written action plan ^[8]. Inform them that you have received an intramuscular hydrocortisone injection but may still require intravenous fluids, electrolyte correction, and further steroid treatment ^[10][16].