Section 1 - CHEMICAL PRODUCT AND COMPANY IDENTIFICATION

PRODUCT NAME

HYDROCORTISONE SODIUM SUCCINATE

NFPA

PRODUCT USE

Hydrocortisone is the main glucocorticoid secreted from the adrenal cortex. Used in
replacement therapies and as an anti- inflammatory agent. Hydrocortisone sodium succinate
is administered by intramuscular or slow intravenous injection in intensive therapy or in
emergencies It is especially useful i.v. in acute adrenocortical insufficiency and severe
status asthmaticus. As a lozenge is used in the treatment of apthous ulceration.

SYNONYMS

C25-H33-Na-O8, "cortisol, succinate, sodium salt", "cortisol hemisuccinate sodium",
"cortisol, 21-(hydrogen succinate), monosodium salt", "cortisol, 21-(hydrogen
succinate), monosodium salt", "cortisol sodium hemisuccinate", "cortisol 21-sodium
succinate", "cortisol 21-sodium succinate", "hydrocortisone 21-sodium succinate",
"hydrocortisone 21-sodium succinate", "sodium hydrocortisone 21-succinate", "sodium
hydrocortisone 21-succinate", A-hydrocort, Buccalsone, Corlan, "Ef-Cortelan Soluble", EMI-
Cortlin, Flebocortid, Hycorace, Intracort, Nordicort, Oralsone, Solu-Cortef, Solu-Glyc, U-
4905, corticosteroid, "corticoid anti-inflammatory"

Section 2 - HAZARDS IDENTIFICATION

CANADIAN WHMIS SYMBOLS

EMERGENCY OVERVIEW

RISK

POTENTIAL HEALTH EFFECTS

ACUTE HEALTH EFFECTS

SWALLOWED

  Accidental ingestion of the material may be damaging to the health of the individual.  The corticosteroids cause alterations in metabolism of fats, proteins and carbohydrates, and affect a range of organs in the body including the heart, muscle and kidneys. Blood chemistry may change and there is decreased activity and shrinkage of the thymus gland, adrenal glands, spleen and lymph nodes. The liver becomes enlarged, thyroid activity decreases, and mineral is drawn away from bone. Muscle wasting occurs, and the immune system is adversely affected causing the person to be more susceptible to infections, especially of the eye. Allergies can occur. Wound healing is slowed. In large doses, corticosteroids cause a severe chemical imbalance in the body's minerals, leading to salt and water being retained in the body, causing swelling and high blood pressure. This is more severe when natural rather than synthetic drugs are used. Blood glucose is raised, and in extreme cases the heart may fail. The characteristic "moon-face" appearance may be seen, with weakness of the muscles and bones, high blood pressure, cessation of periods, profuse sweating, mental disturbance, flushing, a humped back, hairiness, and obesity of the trunk with wasting of the arms and limbs ("lemon with matchsticks" shape). These generally improve when treatment is stopped. High pressure in the head, an inflamed pancreas and mental disturbance become more common, and bone tissue may die. The blood also condenses more easily leading to an increased risk of clots. Psychiatric changes include mood swings, personality changes, severe depression and psychosis (hallucinations and delusions). One should be beware of an increased susceptibility to a wide range of infections which may be masked by the ability of corticosteroids to reduce pain, inflammation and fever. Those with ulcers, gastrointestinal disease, kidney impairment, hypothyroidism, high blood pressure, liver damage and osteoporosis may be especially susceptible to the adverse effects of corticosteroids. Prolonged exposure can cause cataracts and eye nerve damage, leading to blindness.  

EYE

  If applied to the eyes, this material causes severe eye damage.  When applied to the eye, corticosteroids may produce ulceration of the cornea, raised eye pressure and reduced vision; internal administration can cause cataracts.  

SKIN

  The material is not thought to be a skin irritant (as classified using animal models). Abrasive damage however, may result from prolonged exposures. Good hygiene practice requires that exposure be kept to a minimum and that suitable gloves be used in an occupational setting.  Skin contact with the material may damage the health of the individual; systemic effects may result following absorption.  Open cuts, abraded or irritated skin should not be exposed to this material.  Entry into the blood-stream, through, for example, cuts, abrasions or lesions, may produce systemic injury with harmful effects. Examine the skin prior to the use of the material and ensure that any external damage is suitably protected.  Topically applied corticosteroids may be absorbed in sufficient quantity to produce systemic effects. Application to the skin may result in collagen loss and subcutaneous atrophy and local bleaching of deeply pigmented skin. Systemic absorption may produce adrenal suppression and collapse.  

INHALED

  Inhalation may produce health damage*.  The material is not thought to produce respiratory irritation (as classified using animal models). Nevertheless inhalation of dusts, or fume, especially for prolonged periods, may produce respiratory discomfort and occasionally, distress.  Inhalation of dusts, generated by the material during the course of normal handling, may be damaging to the health of the individual.  Persons with impaired respiratory function, airway diseases and conditions such as emphysema or chronic bronchitis, may incur further disability if excessive concentrations of particulate are inhaled.  Systemic absorption of aerosols containing corticosteroids may produceadrenal insufficiency and collapse.  

CHRONIC HEALTH EFFECTS

  Limited evidence suggests that repeated or long-term occupational exposure may produce cumulative health effects involving organs or biochemical systems.  There is limited evidence that, skin contact with this product is more likely to cause a sensitization reaction in some persons compared to the general population.  There is some evidence that human exposure to the material may result in developmental toxicity. This evidence is based on animal studies where effects have been observed in the absence of marked maternal toxicity, or at around the same dose levels as other toxic effects but which are not secondary non-specific consequences of the other toxic effects.  Long term exposure to high dust concentrations may cause changes in lung function i.e. pneumoconiosis; caused by particles less than 0.5 micron penetrating and remaining in the lung. Prime symptom is breathlessness; lung shadows show on X-ray.  Exposure to the material for prolonged periods may cause physical defects in the developing embryo (teratogenesis).  Chronic exposure to glucocorticoids can lead to changes in hormone production, a characteristic "moon face" appearance and a "lemon with matchsticks" fat distribution (central obesity with wasting of limbs), susceptibility to infections, osteoporosis, cataracts, glaucoma, mental disturbance, high blood sugar and sugar in the urine. There may be muscular weakness and fatigue, acne, period disturbances in women and peptic ulcers. Growth retardation can occur in children and birth defects are possible. Corticosteroids appear in human milk and ' may stunt the growth of infants.  Over-exposure may also cause reproductive disorders.