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Case Reports
. 2019 Jul 22;3(3):282-285.
doi: 10.5811/cpcem.2019.5.43118. eCollection 2019 Aug.

Trimethoprim/Sulfamethoxazole-Induced Bradycardia, Renal Failure, AV-Node Blockers, Shock and Hyperkalemia Syndrome

Nnaemeka Diribe  1 , Jacqueline Le  1
Affiliations
Case Reports

Trimethoprim/Sulfamethoxazole-Induced Bradycardia, Renal Failure, AV-Node Blockers, Shock and Hyperkalemia Syndrome

Nnaemeka Diribe et al. Clin Pract Cases Emerg Med. .

Abstract

BRASH (bradycardia, renal failure, atrioventricular-node blockers, shock, and hyperkalemia) syndrome is a recently coined term for a condition that describes the severe bradycardia and shock associated with hyperkalemia in patients on atrioventricular (AV)-node blocking agents. The proposed pathophysiology involves a precipitating event that exacerbates renal dysfunction with resulting AV-node blocker and potassium accumulation that act synergistically to precipitate bradycardia and hypotension. This syndrome may be refractory to the usual management of bradycardia. This case describes BRASH syndrome precipitated by trimethoprim/sulfamethoxazole.

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Conflict of interest statement

Conflicts of Interest: By the CPC-EM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Image
Image
Initial electrocardiogram of 51-year-old male showing third-degree atrioventricular block with a ventricular escape rhythm. There is marked bradycardia (39 beats/minute), peaked T waves, and widened QRS (173 milliseconds).
Figure
Figure
Management considerations for BRASH – bradycardia, renal failure, atrioventricular-node blockers, shock, and hyperkalemia – syndrome.
See this image and copyright information in PMC

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