BRASH Syndrome with Hyperkalemia: An Under-Recognized Clinical Condition

Methodist Debakey Cardiovasc J. 2020 Jul-Sep;16(3):241-244. doi: 10.14797/mdcj-16-3-241.

Abstract

BRASH syndrome is characterized by bradycardia, renal failure, use of an atrioventricular nodal blocker (AVNB), shock, and hyperkalemia. These symptoms represent an ongoing vicious cycle in a patient with a low glomerular filtration rate taking an AVNB. Decreased clearance of the medication and hyperkalemia associated with renal failure synergize to cause bradycardia and hypoperfusion. This reaction causes renal function to worsen, thereby perpetuating the cycle of BRASH syndrome.

Keywords: BRASH syndrome; atrioventricular nodal blocker; bradycardia; hyperkalemia; renal failure; shock.

Publication types

  • Case Reports

MeSH terms

  • Antihypertensive Agents / adverse effects*
  • Atrioventricular Node / drug effects*
  • Atrioventricular Node / physiopathology
  • Bradycardia / chemically induced*
  • Bradycardia / diagnosis
  • Bradycardia / physiopathology
  • Bradycardia / therapy
  • Diltiazem / adverse effects*
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Hyperkalemia / diagnosis
  • Hyperkalemia / etiology*
  • Hyperkalemia / physiopathology
  • Hyperkalemia / therapy
  • Kidney / physiopathology
  • Middle Aged
  • Renal Insufficiency, Chronic / complications*
  • Renal Insufficiency, Chronic / diagnosis
  • Renal Insufficiency, Chronic / therapy
  • Syndrome
  • Treatment Outcome

Substances

  • Antihypertensive Agents
  • Diltiazem