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

Jasti, Jaswanth Rao; Jasty, Tirumala Nischal; Gudiwada, Mohan Chandra Vinay Bharadwaj; Jitta, Sahas Reddy

doi:10.7759/cureus.34803

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Treatment aims to stabilize the cardiac membrane with calcium gluconate and hemodynamic support with IV fluids and vasopressors if required. Underlying hyperkalemia needs to be managed with agents associated with reducing total body potassium [ 5 , 8 ]. Advanced therapies are reserved for patients refractory to treatment, requiring dialysis and/or temporary transvenous pacing whenever initial management fails [ 1 , 9 ].…”

Section: Discussionmentioning

confidence: 99%

Bradycardia, Renal Failure, Atrioventricular Nodal Block, Shock, and Hyperkalemia (BRASH) Syndrome-Induced Atrial Fibrillation: A Case Report

Santos Argueta,

Ali,

Amin

2024

Cureus

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BRASH syndrome is a syndrome that comprises bradycardia, renal failure, atrioventricular nodal block, shock, and hyperkalemia. This syndrome is usually associated with a junctional rhythm. Early recognition of this clinical entity is crucial for appropriate management. In this case report, we describe a 70-year-old female who presented with BRASH syndrome-induced atrial fibrillation with a slow ventricular response.

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Section: Discussionmentioning

confidence: 99%

Bradycardia, Renal Failure, Atrioventricular Nodal Block, Shock, and Hyperkalemia (BRASH) Syndrome-Induced Atrial Fibrillation: A Case Report

Santos Argueta,

Ali,

Amin

2024

Cureus

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“…Blood potassium levels are essential for the proper functioning of the heart, nerves, and muscles. Acute abnormalities in serum potassium, such as hyperkalemia or hypokalemia, can cause serious problems, such as arrhythmias 1 – 3 and muscle weakness 4 . In the emergency department, patients with critical conditions, such as heart attacks and serious infections, are often treated.…”

Section: Introductionmentioning

confidence: 99%

Logistic analysis of delayed reporting of emergency blood potassium and comparison of improved outcomes

Zhang,

Lv,

Jin

et al. 2024

Sci Rep

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Potassium testing is an essential test in emergency medicine. Turnaround time (TAT) is the time between specimen receipt by the laboratory and the release of the test report. A brief in-laboratory TAT increases emergency department effectiveness. Optimizing processes to shorten TAT using other tools requires extensive time, resources, training, and support. Therefore, we aimed to find a convenient way to shorten TAT, identify risk factors affecting the timeliness of emergency potassium test reporting, and verify the intervention’s effects. The dependent variable was emergency potassium reporting time > 30 or < 30 min. Logistic analysis was performed on monitorable factors, such as sex, age, potassium results, number of items, specimen processing time (including centrifugation and time before specimen loading), critical value ratio, instrument status, shift where the report was issued, specimen status, and work experience, as independent variables. In the multivariate analysis, work experience, instrument failure rate, and specimen processing time were risk factors for emergency blood potassium reporting exceeding 30 min. Improvement measures were implemented, significantly decreasing the timeout rate for acute potassium reporting. Our study confirms the usefulness of logistics in reducing the time required to report potassium levels in the emergency department, providing a new perspective on quality management.

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BRASH syndrome with a complete heart block- a case report

Gebray,

Abeje,

Boye

2024

BMC Cardiovasc Disord

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Introduction BRASH syndrome (Bradycardia, Renal failure, Atrioventricular (AV) nodal blocking agent, Shock and Hyperkalemia) is a recently emerging diagnosis that describes the profound bradycardia seen in patients on AV nodal blockers who present with acute kidney injury (AKI) and hyperkalemia. Case presentation We present a case of a 68 years old female patient with past history of hypertension taking atenolol and Enalapril presented to emergency department with the complaint of loss of consciousness of 02 hours duration. She had 03 days history of fatigue, poor oral intake, decreased urine output, appetite loss, vertigo and global headache. Her vital signs were blood pressure of 60/40 mmHg, absent radial pulse and temperature of 36.4 °C. Her systemic examination was remarkable for dry buccal mucosa; apical heart rate was 22 beats per minute. Glasgow Coma Scale was 13/15. Her laboratory tests showed creatinine of 1.83 mg/dL, blood urea nitrogen of 89 mg/dL and potassium elevated to the level of 6.39 mEq/dL. ECG revealed complete heart block with a normal QT interval and T waves and no U waves with ventricular rate of 22 beats per minute. Her previous medications were discontinued and the patient was resuscitated with intravenous (IV) fluids. She was given 03 doses of 1 mg atropine every 5 minutes but there was no increment in heart rate. She was given 50% dextrose with 10 international units of regular insulin, 1 g of calcium gluconate and Intravenous perfusion of norepinephrine and dopamine. Subsequently, after 14 hours of ICU admission the patient had a cardiac arrest with asystole and resuscitation was attempted but she couldn’t survive. Conclusion BRASH syndrome is largely an under-recognized life threatening clinical diagnosis. Physicians should have high index of suspicion for BRASH when they encounter patients with bradycardia, hyperkalemia, and renal failure, as timely diagnosis is crucial in the management.

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

Cited by 3 publications

References 9 publications

Bradycardia, Renal Failure, Atrioventricular Nodal Block, Shock, and Hyperkalemia (BRASH) Syndrome-Induced Atrial Fibrillation: A Case Report

Bradycardia, Renal Failure, Atrioventricular Nodal Block, Shock, and Hyperkalemia (BRASH) Syndrome-Induced Atrial Fibrillation: A Case Report

Logistic analysis of delayed reporting of emergency blood potassium and comparison of improved outcomes

BRASH syndrome with a complete heart block- a case report

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