Rectal hydrocortisone during vomiting in children with adrenal insufficiency.
OBJECTIVE
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.
Ní Chróinín
M
M
Diabetes and Endocrine Centre, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
Fallon
M
M
Kenny
D
D
Moriarty
S
S
Hoey
H
H
Costigan
C
C
D000285:Administration, Rectal; D000293:Adolescent; D000309:Adrenal Insufficiency / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D020249:Hormone Replacement Therapy / Q000379:methods; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage* / Q000097:blood / Q000493:pharmacokinetics; D007223:Infant; D007273:Injections, Intramuscular / Q000191:economics; D008297:Male; D010349:Patient Compliance; D013488:Suppositories / Q000191:economics / Q000493:pharmacokinetics; D011795:Surveys and Questionnaires; D013997:Time Factors; D014839:Vomiting / Q000150:complications / Q000188:drug therapy*
D013488:Suppositories; D006854:Hydrocortisone