Ghumman Ghulam Mujtaba, Kumar Aakash
Internal Medicine, St. Vincent Mercy Medical Center, Toledo, USA.
Cureus. 2021 Oct 9;13(10):e18628. doi: 10.7759/cureus.18628. eCollection 2021 Oct.
BRASH (bradycardia, renal failure, atrioventricular [AV] nodal blocking medications, shock, hyperkalemia) syndrome describes the phenomenon of profound bradycardia from a combination of hyperkalemia and use of AV nodal blocking medication with underlying renal injury. We present a case of BRASH syndrome in a patient on chronic beta-blocker therapy for his coronary artery disease who presented with life-threatening hyperkalemia and acute renal failure. Due to failure in early recognition and superimposed effect with further beta-blocker dosing, the patient developed profound bradycardia and later went into pulseless electrical activity cardiac arrest requiring cardiopulmonary resuscitation. Metabolic derangements and bradycardia later resolved with medical management, but unfortunately, the patient developed diffuse anoxic brain injury after the cardiac arrest and was declared brain dead.
BRASH（心动过缓、肾衰竭、房室结阻滞剂、休克、高钾血症）综合征描述了高钾血症、使用房室结阻滞剂以及潜在肾损伤共同作用导致严重心动过缓的现象。我们报告一例患有冠状动脉疾病并接受慢性β受体阻滞剂治疗的患者发生BRASH综合征，该患者出现危及生命的高钾血症和急性肾衰竭。由于早期识别失败以及进一步使用β受体阻滞剂产生叠加效应，患者出现严重心动过缓，随后发展为无脉性电活动心脏骤停，需要进行心肺复苏。代谢紊乱和心动过缓经药物治疗后得到缓解，但不幸的是，患者在心脏骤停后出现弥漫性缺氧性脑损伤，最终被宣布脑死亡。
