BRASH syndrome

BRASH syndrome:

A 62-year-old woman with chronic kidney disease stage 4, sleep apnoea on continuous positive airway pressure and recent admission for acute-on-chronic diastolic heart failure presented to emergency room with weakness. She was hypotensive and had symptomatic bradycardia in the 30 s secondary to hyperkalaemia and beta-blockers, raising concern for BRASH syndrome. Antihypertensives were immediately held. Potassium-lowering agents (with calcium gluconate for cardiac stability) were begun, as were fluids and dopamine for vasopressor support. The patient was admitted to intensive care unit and electrophysiology was consulted. Over the next 2 days, the patient clinically improved: she remained off dopamine for over 24 hours; potassium levels and renal function improved; and heart rate stabilised in 60 s. The patient was eventually discharged and advised to avoid metolazone, bumetanide and carvedilol, with primary care provider and cardiology follow-up.

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BRASH syndrome refers to a vicious cycle which may occur when a patient taking AV node blockers develops renal failure and hyperkalemia. This leads to a spiral of worsening hyperkalemia, renal failure, and bradycardic shock.Feb 15, 2016

PulmCrit- BRASH syndrome: Bradycardia, Renal failure, Av ...