Indian Journal of Critical Care Case Report

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VOLUME 1 , ISSUE 3 ( November-December, 2022 ) > List of Articles


Life-threatening Complication in a Patient with Chronic Kidney Disease: BRASH Syndrome

Deven Juneja

Keywords : Bradycardia, Hyperkalemia, Hypotension, Renal dysfunction, Shock

Citation Information : Juneja D. Life-threatening Complication in a Patient with Chronic Kidney Disease: BRASH Syndrome. 2022; 1 (3):70-72.

DOI: 10.5005/jp-journals-11006-0023

License: CC BY-NC 4.0

Published Online: 02-01-2023

Copyright Statement:  Copyright © 2022; The Author(s).


Introduction: Patients admitted to intensive care units (ICU) often have multiple co-morbidities and are on several drugs. These medications may have drug interactions that may complicate the disease course of the patient. Case description: Here, we describe a patient with chronic kidney disease on atrioventricular (AV) nodal-blocking drugs who developed refractory bradycardia and shock, managed with emergency dialysis. Conclusions: A new clinical entity of bradycardia, renal failure, AV nodal blocking drugs, shock, and hyperkalemia (BRASH) syndrome has been described in which patients with underlying renal dysfunction may develop bradycardia, hyperkalemia, and shock when prescribed AV nodal blocking agents. Bradycardia and shock may be life-threatening and refractory to standard therapy. Hence, physicians should be aware of the underlying pathophysiology and therapeutic measures required to manage BRASH syndrome in order to improve patient outcomes.

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