Life threatening situation? Always call 112

Addison! Hydrocortisone! (or dexamethasone)

by Hans Essers – emergency care physician

Taken from the newsletter framework general practitioners emergency care September 2021. 

There is regular contact with patients with adrenal gland problems during ANW hours. So please pay attention to the mailing below.  

In consultation with the pharmacists, hydrocortisone has become available parenterally on the visiting car. It is also recommended to contact the practitioner at the hospital. 

Recently, the new guideline of the Dutch College of General Practitioners was published: Oxygen and medication in emergency situations. In this guideline (despite this news item) the use of hydrocortisone has been replaced by dexamethasone. In addition, the NHG recommends either hydrocortisone or dexamethasone in the event of an Addisonian crisis. This advice can be found in the document Information for the general practitioner about adrenal gland diseases. It contains more information about adrenal cortical diseases and an Addisonian crisis. 
See also www.bijniernet.nl/2021/01/goede-vraag-over-de-spoedmedicatie-op-de-huisartsenpost/  

  • For patients with an imminent adrenal crisis, we recommend using the ampoule for the emergency injection of the type that the patient is carrying. In general, people use hydrocortisone (often in the form of Solcortef act-o-vial) and sometimes dexamethasone. 
  • If the patient does not have an ampoule for the emergency injection or is unable to tell which type of medication is being used, it is preferable to use Solucortef-act-o-vial (hydrocortisone) for the following reasons: 
  • Solucortef-act-o-vial is suitable for personal use. 
  • Administration can be done quickly. 
  • Hydrocortisone is a body’s own hormone that is normally produced by the adrenal gland. 
  • Prednisolone and dexamethasone, on the other hand, are synthetic glucocorticoids, which are not normally found in the body and have a longer duration of action. 
  • Regardless of the primary reason for the need for care, the agreement is that in the event of an imminent adrenal crisis, the treating internist-endocrinologist will always be contacted or, in the case of children and adolescents, the paediatrician-endocrinologist. 

Conclusion: in the emergency medication at the out-of-hours GP service, it is therefore preferable that an emergency ampoule of Solu-cortef act-o-vial (hydrocortisone) is also present in case a patient with adrenal insufficiency reports to the out-of-hours GP service.

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