Citation Information :
JH HR, R MK, Sundarsingh V, Misquith LA, K F. A Rare Case of BRASH Syndrome: Diagnostic and Therapeutic Challenges. 2025; 4 (2):50-53.
Aim and background: BRASH syndrome (bradycardia, renal failure, AV-nodal blockade, shock, and hyperkalemia) is a rare and underrecognized clinical entity that poses significant diagnostic and therapeutic challenges.
Case description: We report the case of a 75-year-old female with multiple comorbidities presenting with symptomatic bradycardia and shock due to BRASH syndrome, triggered by AV nodal-blocking medications and sepsis-induced hypovolemia. Early recognition, prompt discontinuation of precipitating drugs, correction of hyperkalemia, and hemodynamic stabilization resulted in a favorable outcome.
Conclusion: This case underscores the importance of timely diagnosis and comprehensive management to prevent complications, reduce the need for invasive interventions, and improve overall patient outcomes in BRASH syndrome.
Clinical significance: In elderly patients with multiple comorbidities, combining calcium channel blockers (CCBs) and beta-blockers should be done with caution. Vigilant monitoring for BRASH features is essential, and even mild hyperkalemia must be treated promptly. Early recognition and tailored management can improve outcomes in BRASH syndrome.
Farkas JD, Long B, Koyfman A, et al. BRASH syndrome: bradycardia, renal failure, AV blockade, shock, and hyperkalemia. J Emerg Med 2020;59(2):216–223. DOI: 10.1016/j.jemermed.2020.05.001
Adverse drug reaction probability scale (Naranjo) in drug induced liver injury. In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012. Available from: http://www.ncbi.nlm.nih.gov/books/NBK548069/.
Farkas J. PulmCrit-BRASH syndrome: bradycardia, renal failure, Av blocker, shock, hyperkalemia. EMCrit Project. 2016. Available from: https://emcrit.org/pulmcrit/brash-syndrome-bradycardia-renal-failure-av-blocker-shock-hyperkalemia/.
Srivastava S, Kemnic T, Hildebrandt KR. BRASH syndrome. BMJ Case Rep 2020;13(2):e233825. DOI: 10.1136/bcr-2019-233825
Habib A. BRASH syndrome: a rare but reversible cause of sinus node dysfunction. HeartRhythm Case Rep 2024;10(6):398–401. DOI: 10.1016/j.hrcr.2024.03.005
Majeed H, Khan U, Khan AM, et al. BRASH syndrome: a systematic review of reported cases. Curr Probl Cardiol 2023;48(6):101663. DOI: 10.1016/j.cpcardiol.2023.101663
Saini T, Reny J, Hennawi HA, et al. The vicious cycle of BRASH syndrome: a case report. Glob Cardiol Sci Pract 2023;2023(1):e202302. DOI: 10.21542/gcsp.2023.2
Shah P, Silangruz K, Lee E, et al. Two cases of BRASH syndrome: a diagnostic challenge. Eur J Case Rep Intern Med 2022;9(4):003314. DOI: 10.12890/2022_003314
Ghallab M, Noff NC, Sandhu J, et al. A case report of BRASH (bradycardia, renal failure, atrioventricular (AV) blockage, shock, and hyperkalemia) syndrome with a challenging diagnosis and management dilemma. Cureus 2023;15(10):e46413. DOI: 10.7759/cureus.46413
Imburgio S, Johal A, Udongwo N, et al. BRASH syndrome: a case report and literature review. J Integr Cardiol Open Access 2022;2022(3):1–4. DOI: 10.31487/j.JICOA.2022.03.05
