Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock, and Hyperkalemia (BRASH) Syndrome: A Rising Entity of Severe Bradycardia

Bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia (BRASH) syndrome is an entity recently coined to describe this clinical pentad. Although the condition is rare, early recognition is paramount. It ensures prompt appropriate intervention is administered, as conventi...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2023-02, Vol.15 (2), p.e35620
Main Authors: Ng, Choong Tatt, Lim, Kai Xiong, Loo, Khang Ning
Format: Article
Language:English
Subjects:
Acidosis
Blood
Cardiac arrhythmia
Cardiology
Case reports
Creatinine
Diuretics
Electrocardiography
Emergency medical care
Heart rate
Hemodialysis
Hyperkalemia
Hypertension
Internal Medicine
Kidney diseases
Laboratories
Metabolism
Nephrology
Patients
Potassium
Sinuses
Sodium
Urine
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Summary:Bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia (BRASH) syndrome is an entity recently coined to describe this clinical pentad. Although the condition is rare, early recognition is paramount. It ensures prompt appropriate intervention is administered, as conventional management for bradycardia as guided by advanced cardiac life support (ACLS) is ineffective in the BRASH syndrome. Here, we describe a case of an elderly lady with hypertension and chronic kidney disease presenting to the emergency department with dyspnoea and confusion. She was found to have bradycardia, hyperkalemia, and acute kidney injury. Notably, she had recent changes in her medications in view of poorly controlled hypertension two days before the presentation. Her Bisoprolol 5mg every morning was changed to Carvedilol 12.5mg twice daily, and Amlodipine 10mg every morning was changed to Nifedipine long-acting 60mg twice daily. Initial treatment with atropine for bradycardia was ineffective. However, when the BRASH syndrome was identified and treated, the patient's condition improved, and she averted complications such as multiorgan failure without the need for dialysis or cardiac pacing. Early detection of bradycardia via smart devices could be considered in patients at higher risk of BRASH syndrome.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.35620