BRASH syndrome: More than just syncope

Divya Vangipuram MD, Kenneth Nugent MD

ABSTRACT

The pentad of bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia describes the BRASH syndrome, a newly recognized phenomenon in which accumulation of potassium and renally excreted atrioventricular nodal blockers cause a cycle of bradycardia, hypoperfusion, and worsening renal function. Here, we describe a case of BRASH in an elderly woman whose medications had recently changed, and who presented with bradycardia, anuria, and hypotension. Resolution of symptoms occurred over hours after the correct treatment was started. Furthermore, we review case reports written in recent years for common BRASH syndrome patient characteristics.

Keywords: Bradycardia, hyperkalemia, shock, AV nodal blocker, critical care

Article citation: Vangipuram D, Nugent K. BRASH syndrome: More than just syncope. The Southwest Respiratory and Critical Care Chronicles 2021;9(40): 53–59
From: Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
Submitted: 4/25/2021
Accepted: 6/25/2021
Reviewer: Deephak Swaminath MD
Conflicts of interest: none
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