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Case Reports
. 2025 May 12:2025:3405566.
doi: 10.1155/crin/3405566. eCollection 2025.

BRASH Syndrome: A Patient With Chronic Kidney Disease and AV Nodal Blockers

Zein A Alsayed-Ahmad  1 , Sanaa Saddour  1 , Tasnim Mustafa Saddour  1 , Mohamad Moafak Hariri  1 , Karam Albitar  2 , Sami Albitar  1
Affiliations
Case Reports

BRASH Syndrome: A Patient With Chronic Kidney Disease and AV Nodal Blockers

Zein A Alsayed-Ahmad et al. Case Rep Nephrol. .

Abstract

Background: BRASH syndrome is a life-threatening condition that involves bradycardia, renal failure, atrioventricular blockade, shock, and hyperkalemia. It is often resistant to conventional treatments and requires prompt diagnosis and management. We report a case of BRASH syndrome successfully treated in the Emergency Department and Nephrology Department. Case Presentation: A 57-year-old man with hypertension, diabetes, ischemic heart disease, and chronic kidney disease presented with severe diarrhea, lethargy, and shock. He had hyperkalemia, metabolic acidosis, and acute kidney injury. His electrocardiogram showed sinus bradycardia with complete AV block. He was on bisoprolol, which was discontinued. He received hemodialysis, potassium-lowering agents, and vasoactive drugs. His renal function improved, and his heart rate normalized with first-degree AV block. He was discharged with advice to avoid AV-blocking agents and follow-up with nephrology and cardiology. Conclusions: BRASH syndrome is a serious complication of hyperkalemia, hypotension, and bradycardia in patients with kidney dysfunction and AV-blocking medications. It may require hemodynamic support and temporary pacemaker insertion. Early recognition and treatment of this entity can reduce mortality and morbidity.

Keywords: BRASH syndrome; atrioventricular blockade; bradycardia; case report; hemodialysis; hyperkalemia; renal failure.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Admission ECG showing sinus bradycardia with complete AV block.
Figure 2
Figure 2
Discharge ECG showing first-degree block.
See this image and copyright information in PMC

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