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Case Reports
. 2020 Feb 23;13(2):e233825.
doi: 10.1136/bcr-2019-233825.

BRASH syndrome

Shaurya Srivastava  1 , Tyler Kemnic  2   3 , Kyle R Hildebrandt  4
Affiliations
Case Reports

BRASH syndrome

Shaurya Srivastava et al. BMJ Case Rep. .

Abstract

A 62-year-old woman with chronic kidney disease stage 4, sleep apnoea on continuous positive airway pressure and recent admission for acute-on-chronic diastolic heart failure presented to emergency room with weakness. She was hypotensive and had symptomatic bradycardia in the 30 s secondary to hyperkalaemia and beta-blockers, raising concern for BRASH syndrome. Antihypertensives were immediately held. Potassium-lowering agents (with calcium gluconate for cardiac stability) were begun, as were fluids and dopamine for vasopressor support. The patient was admitted to intensive care unit and electrophysiology was consulted. Over the next 2 days, the patient clinically improved: she remained off dopamine for over 24 hours; potassium levels and renal function improved; and heart rate stabilised in 60 s. The patient was eventually discharged and advised to avoid metolazone, bumetanide and carvedilol, with primary care provider and cardiology follow-up.

Keywords: adult intensive care; fluid electrolyte and acid-base disturbances; pacing and electrophysiology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Admission EKG showing HR 31,junctional rhythm and peaked T-waves. HR, heart rate.
Figure 2
Figure 2
Follow-up EKG showing HR 61, normal sinus rhythm. HR, heart rate.
See this image and copyright information in PMC

References

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