Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
J Emerg Med. 2021 Jun;60(6):818-822. doi: 10.1016/j.jemermed.2021.01.033. Epub 2021 Feb 24.
BRASH syndrome, a relatively new entity, has been described in the recent literature. It is defined as a combination of bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia. Although it is apparent that clinical symptomatology includes shock, it is still unclear whether all patients will initially present with all five components mentioned in the BRASH acronym.
An elderly woman presented to our Emergency Department (ED) with hyperkalemia, acute renal failure, and metabolic acidosis with bradycardia, which was refractory to antikalemic measures and atropine. The montage of clinical features put together showed a clear picture of BRASH syndrome, which helped us to streamline the management and achieve a better patient outcome. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Renal failure with various metabolic derangements is commonly seen in the ED. We should be aware of this new clinical entity, as its incidence will certainly increase, and the management is a bit different. Prognosis is excellent with timely recognition and management of this rare clinical entity.
BRASH 综合征是一种相对较新的病症，最近的文献中有相关描述。它被定义为心动过缓、肾衰竭、房室结阻滞、休克和高钾血症的组合。尽管很明显临床症状包括休克，但仍不清楚是否所有患者最初都会出现 BRASH 缩写中提到的所有五个成分。
一位老年女性因高钾血症、急性肾衰竭和代谢性酸中毒伴心动过缓而到我们的急诊科就诊，心动过缓对抗高钾血症措施和阿托品治疗无反应。临床特征的组合清楚地表明了 BRASH 综合征，这有助于我们简化管理并实现更好的患者预后。
为什么急诊医生应该了解这个病症？：在急诊科，肾衰竭伴有各种代谢紊乱是很常见的。我们应该意识到这种新的临床实体，因为它的发病率肯定会增加，而且管理方法略有不同。及时识别和管理这种罕见的临床实体，预后良好。
