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Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock and Hyperkalemia (BRASH) Syndrome: A Clinical Case Study

BRASH syndrome, which stands for Bradycardia, Renal failure, Atrioventricular (AV) Nodal blockade, and shock, is a relatively new clinical condition. Bradycardia develops because of the synergistic effect of AV-nodal blockers and hyperkalemia in a renal failure resulting in a vicious cycle of progre...

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Autores principales: Jasti, Jaswanth R, Jasty, Tirumala Nischal, Gudiwada, Mohan Chandra Vinay Bharadwaj, Jitta, Sahas Reddy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9915857/
https://www.ncbi.nlm.nih.gov/pubmed/36788997
http://dx.doi.org/10.7759/cureus.34803
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author Jasti, Jaswanth R
Jasty, Tirumala Nischal
Gudiwada, Mohan Chandra Vinay Bharadwaj
Jitta, Sahas Reddy
author_facet Jasti, Jaswanth R
Jasty, Tirumala Nischal
Gudiwada, Mohan Chandra Vinay Bharadwaj
Jitta, Sahas Reddy
author_sort Jasti, Jaswanth R
collection PubMed
description BRASH syndrome, which stands for Bradycardia, Renal failure, Atrioventricular (AV) Nodal blockade, and shock, is a relatively new clinical condition. Bradycardia develops because of the synergistic effect of AV-nodal blockers and hyperkalemia in a renal failure resulting in a vicious cycle of progressive bradycardia, renal hypoperfusion, and hyperkalemia. We present a case of an 88-year-old man with chronic systolic heart failure, atrial fibrillation, stage 3 chronic kidney disease, and dementia who presented to our emergency department with poor oral intake and weakness. He was found to have symptomatic bradycardia in the 30s secondary to hyperkalemia and beta-blockers in the setting of acute renal failure from dehydration, raising concern for BRASH syndrome. Treatment of each component conservatively resulted in complete resolution without the need for aggressive measures such as dialysis or pacing. This case report also discusses the pathophysiology, management, and the need for recognizing this underdiagnosed and novel clinical condition.
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spelling pubmed-99158572023-02-13 Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock and Hyperkalemia (BRASH) Syndrome: A Clinical Case Study Jasti, Jaswanth R Jasty, Tirumala Nischal Gudiwada, Mohan Chandra Vinay Bharadwaj Jitta, Sahas Reddy Cureus Internal Medicine BRASH syndrome, which stands for Bradycardia, Renal failure, Atrioventricular (AV) Nodal blockade, and shock, is a relatively new clinical condition. Bradycardia develops because of the synergistic effect of AV-nodal blockers and hyperkalemia in a renal failure resulting in a vicious cycle of progressive bradycardia, renal hypoperfusion, and hyperkalemia. We present a case of an 88-year-old man with chronic systolic heart failure, atrial fibrillation, stage 3 chronic kidney disease, and dementia who presented to our emergency department with poor oral intake and weakness. He was found to have symptomatic bradycardia in the 30s secondary to hyperkalemia and beta-blockers in the setting of acute renal failure from dehydration, raising concern for BRASH syndrome. Treatment of each component conservatively resulted in complete resolution without the need for aggressive measures such as dialysis or pacing. This case report also discusses the pathophysiology, management, and the need for recognizing this underdiagnosed and novel clinical condition. Cureus 2023-02-09 /pmc/articles/PMC9915857/ /pubmed/36788997 http://dx.doi.org/10.7759/cureus.34803 Text en Copyright © 2023, Jasti et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Internal Medicine
Jasti, Jaswanth R
Jasty, Tirumala Nischal
Gudiwada, Mohan Chandra Vinay Bharadwaj
Jitta, Sahas Reddy
Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock and Hyperkalemia (BRASH) Syndrome: A Clinical Case Study
title Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock and Hyperkalemia (BRASH) Syndrome: A Clinical Case Study
title_full Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock and Hyperkalemia (BRASH) Syndrome: A Clinical Case Study
title_fullStr Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock and Hyperkalemia (BRASH) Syndrome: A Clinical Case Study
title_full_unstemmed Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock and Hyperkalemia (BRASH) Syndrome: A Clinical Case Study
title_short Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock and Hyperkalemia (BRASH) Syndrome: A Clinical Case Study
title_sort bradycardia, renal failure, atrioventricular nodal blockade, shock and hyperkalemia (brash) syndrome: a clinical case study
topic Internal Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9915857/
https://www.ncbi.nlm.nih.gov/pubmed/36788997
http://dx.doi.org/10.7759/cureus.34803
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