318: An Atypical Case of COVID-19 and Renal Amyloidosis Presenting With BRASH Syndrome

Gulati, Uday; Nanduri, Ananya; Juneja, Prateek; R., Anshul, Kumar,

doi:10.1097/01.ccm.0000727160.71473.d9

Cited by 3 publications

(4 citation statements)

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“…Prior case studies have also implicated amiodarone in the onset of BRASH syndrome [9,10]. The patient had been tolerating the above medications well for a long duration and the development of renal failure and subsequent risk of BRASH in this specific case was likely triggered by hypovolemia resulting from gastrointestinal losses.…”

Section: Discussionmentioning

confidence: 73%

“…We hypothesize that amiodarone, the sole AV nodal blocking agent in our case, could have contributed to the suppression of the AV node, leading to the emergence of BRASH syndrome in this patient. Prior case studies have also implicated amiodarone in the onset of BRASH syndrome [ 9 , 10 ]. The patient had been tolerating the above medications well for a long duration and the development of renal failure and subsequent risk of BRASH in this specific case was likely triggered by hypovolemia resulting from gastrointestinal losses.…”

Section: Discussionmentioning

confidence: 99%

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When a Cure Becomes a Curse: The Complex Clinical Scenario Involving Amiodarone Therapy and BRASH (Bradycardia, Renal failure, Atrioventricular Nodal Blockade, Shock, and Hyperkalemia) Syndrome

Phuyal¹,

Moond²,

Catahay³

et al. 2023

Cureus

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BRASH [bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia] syndrome is a recently recognized clinical condition that is rare but can be potentially life-threatening. Its pathogenesis is characterized by a self-perpetuating cycle of bradycardia that is potentiated by the concomitant occurrence of medication use, hyperkalemia, and renal failure. AV nodal blocking agents are commonly implicated in BRASH syndrome. We report a case of a 97-year-old female patient with a medical history of heart failure with preserved ejection fraction, atrial fibrillation, hypertension, hyperlipidemia, and hypothyroidism who presented to the emergency department with a one-day history of diarrhea and vomiting. Upon presentation, the patient was hypotensive, bradycardic, and had severe hyperkalemia, acute renal failure, and anion gap metabolic acidosis, raising concern for BRASH syndrome. The treatment of each component of BRASH syndrome resulted in the resolution of the symptoms. The association of BRASH syndrome with amiodarone, the only AV nodal blocking agent in this particular case, is not commonly reported.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

When a Cure Becomes a Curse: The Complex Clinical Scenario Involving Amiodarone Therapy and BRASH (Bradycardia, Renal failure, Atrioventricular Nodal Blockade, Shock, and Hyperkalemia) Syndrome

Phuyal¹,

Moond²,

Catahay³

et al. 2023

Cureus

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“…Of the 66 patients, 65 were on a beta-blocker or calcium channel blocker. One patient's 26 source of AV nodal blockade was due to amiodarone. Two of the 66 patients died.…”

Section: Discussionmentioning

confidence: 99%

“…19 However, in two cases, antibiotics and nephrotic syndrome were implicated in the development of BRASH syndrome. 8,26…”

Section: Discussionmentioning

confidence: 99%

BRASH syndrome: more than just syncope

Vangipuram

Nugent

2021

The Chronicles

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The pentad of bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia describes the BRASH syndrome, a newly recognized phenomenon in which accumulation of potassium and renally excreted atrioventricular nodal blockers cause a cycle of bradycardia, hypoperfusion, and worsening renal function. Here, we describe a case of BRASH in an elderly woman whose medications had recently changed, and who presented with bradycardia, anuria, and hypotension. Resolution of symptoms occurred over hours after the right treatment was started. Furthermore, we review case reports written in recent years for common BRASH syndrome patient characteristics.

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