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Rectal hydrocortisone during vomiting in children with adrenal insufficiency
M Ní Chróinín1, M Fallon, D Kenny
1Diabetes and Endocrine Centre, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
Insights
Rectal hydrocortisone is a safe and acceptable emergency treatment for children with adrenal insufficiency. Most parents prefer it over intramuscular injections, though storage can be inconvenient.
Area of Science:
- Pediatric Endocrinology
- Pharmacology
Background:
- Adrenal insufficiency requires emergency glucocorticoid replacement therapy.
- Intramuscular (i.m.) hydrocortisone is a common emergency treatment.
- Alternative routes for hydrocortisone administration are being explored.
Purpose of the Study:
- To evaluate rectal hydrocortisone as an emergency glucocorticoid replacement therapy.
- To compare parental preference and experiences with rectal versus i.m. hydrocortisone.
Main Methods:
- A parental questionnaire assessed treatment preferences, benefits, and drawbacks.
- Data on emergency admissions for adrenal insufficiency were monitored.
- Hydrocortisone levels were measured in a case of treatment failure.
Main Results:
- 93% of surveyed families preferred rectal hydrocortisone.
- Self-administration of rectal hydrocortisone by parents/children increased.
- Rectal hydrocortisone was generally well-tolerated, with similar costs to i.m. injections.
- One case of collapse occurred despite high rectal hydrocortisone levels.
Conclusions:
- Rectal hydrocortisone is an acceptable and safe emergency treatment option for pediatric adrenal insufficiency.
- Intramuscular hydrocortisone remains recommended when rectal administration is not feasible or if suppositories are extruded.
Aim:
To evaluate rectal hydrocortisone as an emergency glucocorticoid replacement therapy in adrenal insufficient children.
Methods:
A parental questionnaire evaluated preferred treatment, problems or benefits of i.m. and rectal hydrocortisone, frequency and indications for administration and who administered treatment. Admissions of children with adrenal insufficiency were monitored.
Results:
There were 39/52 families who responded to the questionnaire. 93% (26/28) preferred rectal hydrocortisone. Parents or children who previously received emergency treatment from a doctor now self-administered rectal hydrocortisone. The cost of suppositories and i.m. hydrocortisone is similar; however, storage of suppositories was inconvenient. One girl presented with pneumonia and collapse despite rectal hydrocortisone and a hydrocortisone level at admission of >2000 nmol/l with normal electrolytes.
Conclusions:
Rectal hydrocortisone is an acceptable and safe emergency therapy. We still advise i.m. hydrocortisone if rectal administration is not possible or with suppository extrusion.