A Case Report of BRASH (Bradycardia, Renal Failure, Atrioventricular (AV) Blockage, Shock, and Hyperkalemia) Syndrome With a Challenging Diagnosis and Management Dilemma

BRASH syndrome, characterized by bradycardia, renal failure, atrioventricular (AV) blockage, shock, and hyperkalemia, is an emerging clinical entity that challenges healthcare practitioners. This case report presents a unique instance of BRASH syndrome with an atypical presentation in a 56-year-old...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2023-10, Vol.15 (10)
Main Authors: Ghallab, Muhammad, Noff, Nicole C, Sandhu, Jasmine, El-ijla, Alli, Makhoul, Karim, Sahibzada, Asad, Munira, Most
Format: Article
Language:English
Subjects:
Acidosis
Beta blockers
Blood pressure
Blood tests
Cardiac arrhythmia
Cardiology
Case reports
Coma
Electrocardiography
Emergency medical care
Emergency Medicine
Heart rate
Hemodialysis
Hyperkalemia
Hypotension
Internal Medicine
Kidney diseases
Medical diagnosis
Metabolism
Pathophysiology
Patients
Pleural effusion
Pneumonia
Potassium
Sepsis
Sinuses
Thyroid gland
Tomography
Toxicity
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Summary:BRASH syndrome, characterized by bradycardia, renal failure, atrioventricular (AV) blockage, shock, and hyperkalemia, is an emerging clinical entity that challenges healthcare practitioners. This case report presents a unique instance of BRASH syndrome with an atypical presentation in a 56-year-old woman with a past medical history of hypertension, diabetes, and chronic kidney disease. Initial laboratory results revealed severe normocytic anemia, thrombocytopenia, renal dysfunction, acidosis, and hyponatremia, alongside hyperkalemia and hypothyroidism. An electrocardiogram depicted sinus arrest with atrial escape rhythms, indicative of severe bradycardia. Imaging studies revealed pleural effusion and ground glass opacities. Management involved anti-hyperkalemic measures, discontinuation of AV nodal-blocking agents, thyroid hormone replacement, and vasopressor support. The patient eventually improved following continuous renal replacement therapy (CRRT) and hemodialysis. The diagnosis of BRASH syndrome emerged as the most likely due to recurrent admissions with similar clinical features. BRASH syndrome represents a complex interplay between AV nodal block and hyperkalemia, leading to severe bradycardia and shock, often affecting older patients with limited renal reserve. While the current literature primarily consists of case reports, raising awareness of BRASH syndrome is crucial for timely intervention and improved patient outcomes. Further research is needed to better understand the mechanisms underlying this syndrome.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.46413