Two Cases of BRASH Syndrome: A Diagnostic Challenge

  • Parthav Shah Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, Hawaii, USA
  • Krixie Silangcruz Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, Hawaii, USA
  • Eric Lee Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, Hawaii, USA
  • Yoshito Nishimura Department of Medicine, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, Hawaii, USA

Keywords

BRASH syndrome, bradycardia, renal failure, atrioventricular nodal blocker, shock, hyperkalemia

Abstract

Bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia (BRASH) syndrome is a relatively new clinical entity. It is often underrecognized, underdiagnosed, and confused with other causes of bradycardia. Treatment of BRASH syndrome differs from the standard bradycardia algorithm in advanced cardiac life support (ACLS), and the cornerstone management remains treating the hyperkalemia, improving renal function by treating the underlying cause, withholding AV nodal blocking agents, and considering dialysis in refractory cases, as any single factor could precipitate the vicious cycle. Here we describe two cases of BRASH syndrome with different clinical presentations that were treated with conservative management: one case in a 77-year-old Japanese woman and the other in an 86-year-old man.

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  • Published: 2022-04-08

    Issue: 2022: Vol 9 No 4 (view)

    Section: Articles

    How to cite:
    1.
    Shah P, Silangcruz K, Lee E, Nishimura Y. Two Cases of BRASH Syndrome: A Diagnostic Challenge. EJCRIM 2022;9 doi:10.12890/2022_003314.