Hereís the recipe for what I call the ďKaiser CocktailĒ:
- Look in the patientís kitchen cupboards until you find a box (or a bag) of some type of granulated sugar, powdered sugar, or brown sugar. (in a pinch, you can use honey or syrup)
- Find one of the patientís own cups or glasses, wash it if you have to.
- Dump a bunch of the sugar in the glass.
- Look in the patientís refrigerator until you find some soda pop or some type of sweet juice like orange, apple, or grape juice.
- Pour that in the glass with the sugar.
- Mix it up really well with some type of stirring device. Donít use your pen or your finger. (Your partnerís pen or finger is ok though.) (Not really.)
- Serve warm, chilled, or tepid. Garnish with a peanut butter and jelly sandwich.
Have you guessed what the ďKaiser Cocktail is used for? If youíre in EMS Iím pretty sure you may have figured it out. Itís for sweetening up your local mild hypoglycemicÖ and no, itís definitely not for serving to my son right before I drop him off with the in-laws for revenge purposes. The Kaiser Cocktail is for those patients who have blood glucose levels in the mid double digits but that still have the mental faculties necessary for drinking fluids and for protecting their airway while they do it. Itís a home remedy of sorts and it isnít exactly the kind of thing that they teach you in EMT school. It works like a charm every time and Iíve never seen it not be well tolerated by the patients Iíve used it on or by the families that watch me do it. In fact, the families always seem more than willing to help whip one right up when I ask them to do so.
Picture this scenario: Your ambulance is dispatched to the ďKnown Diabetic with Altered Mental StatusĒ at an address a short 8 minutes away. You respond to a well kept address in a nice neighborhood and are directed into the residence by a twenty-something female who tells you that her grandfather ďJust isnít acting right and wonít get out of bedĒ. Seeing no obvious hazards, you enter the residence with the granddaughter and follow her to the back bedroom of the residence to find a 60-something male patient sitting on the bed. He acknowledges you when you introduce yourself and you can see that heís trying to talk but that he cannot seem to form the words. You say to him ďHowdy! How are you feeling??Ē He answers: ďUmÖ helloÖĒ with a normal voice quality. His airway is patent, his skin is pink, warm, and sweaty, and he doesnít appear to have any hemispheric neurological deficit. His pulse is bounding and regular at the radial and his respirations are normal. The granddaughter tells you that the patient is diabetic and that he takes insulin.
Got the case diagnosed yet? Iíd bet you do. The next thing I would do with this patient is to take a quick finger stick glucose check. For the above fictional scenario, the reading would be 40mg/dl (which is um… ďsomethingí MMOL for you British folk). Itís mild hypoglycemia. I ruled out a possible stroke (CVA/TIA) with the Cincinnati Pre-Hospital Stroke Scale and he patientís cardiac function seems very normal with his bounding, regular pulse rate. The diaphoresis (sweating) and skin color are differential signs of hypoglycemia, and the patientís past medical history helps clinch the field diagnosis. This patientís blood glucose level dropped too low for his brain to function normally and he needs more sugar coursing through his veins in order to feed his brain.
You may be wondering why I brought forth such a common, run-of-the-mill patient presentation on the blog today. As pre-hospital providers, we have a few options available for us that could be considered proper care for this patient. Most EMTs have oral glucose paste at their disposal and a growing number of EMT-Basics carry Glucagon for IM injection. EMT-Intermediates and Paramedics usually have both of the previous medications available and almost all of them carry D-50, or 50% Dextrose solution in water, for IV administration. All of these treatments could be considered for this patient; however I would pull out my namesake concoction in this case. Call it experience, but starting an IV and giving D-50 seems like it would be risky overkill for this patient and an IM injection of glucagon saps the patientís natural reserves of glycogen for quite a while after administration. Patients seem to hate the taste of oral glucose paste (Lemon?? Really??) and one tube never sees to do the trick. We only care two of them anyway.
Thatís why I use a Kaiser Cocktail with these patients. As long as the patient can maintain their own airway and thereís not an aspiration risk, I canít think of any contraindications once you rule out a possible stroke. Itís cheap, easy, and it has worked like a charm for me every time Iíve tried it. I like using it too, as it feels like a ďMr. WizardĒ type home remedy that always fascinates the patientís family members who watch me make it up.
Hereís the rub though, nowhere in my protocols does it give me authority to give a patient any nourishment or fluids by mouth. In fact, I canít give a patient anything to eat or drink that isnít specifically allowed by my standing orders. In EMS, even something as innocuous as sugared-up orange juice can be a legal difficulty. Common sense isnít allowed by lawyers, unless of course theyíre saying you should have used some. The reality is that every time I whip up a Kaiser Cocktail, Iím putting my license at risk.
I used a Kaiser Cocktail as recently as of the day Iím writing this post and Iím asking for a debate here. Iíd like it if you would please answer some questions for me below the post in the comments section:
- Do you think that the Kaiser Cocktail is an appropriate treatment for mild-to-moderate hypoglycemia in a known-diabetic patient with a patent airway?
- Do you see any contraindications or risks that I have missed?
- Would a tube of oral glucose paste (or tablets, if you use them) be more appropriate than the Kaiser Cocktail?
- Should EMS providers be allowed to improvise treatments such as the Kaiser Cocktail for these and other like situations? Why or Why not?
I canít wait to see your answers.