Pata Ramakanth, Lutaya Innocent, Mefford Molly, Arora Amita, Nway Nway
Pulmonary and Critical Care Medicine, One Brooklyn Health, New York, USA.
Pulmonary and Critical Care Medicine, University of Cincinnati Medical Center, Cincinatti, USA.
Cureus. 2022 Aug 3;14(8):e27641. doi: 10.7759/cureus.27641. eCollection 2022 Aug.
Bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia (BRASH) syndrome commonly occurs in the elderly population with compromised renal function and a history of taking AV nodal blocking agents on a regular basis. Hypovolemia and worsening of renal function are considered to be the major risk factors. BRASH syndrome should be differentiated from pure intoxication with AV nodal blocking agents, as the therapeutic goals of these conditions are different from each other. It encompasses a vicious cycle of bradycardia and decreased cardiac output leading to organ dysfunction including renal failure with hyperkalemia, further augmenting bradycardia. It is usually associated with high morbidity and mortality. Typically, the treatment involves increasing renal blood flow by augmenting cardiac output using catecholamine infusion. Very rarely, interventions such as intralipid emulsion and continuous renal replacement therapy (CRRT) may be required on a case-to-case basis. Promptly recognizing the symptoms of BRASH syndrome can help to avoid diagnostic delays and reduce mortality rates.
心动过缓、肾衰竭、房室（AV）结阻滞、休克和高钾血症（BRASH）综合征常见于肾功能受损且有定期服用AV结阻滞剂病史的老年人群。低血容量和肾功能恶化被认为是主要危险因素。BRASH综合征应与单纯的AV结阻滞剂中毒相鉴别，因为这两种情况的治疗目标彼此不同。它包含心动过缓和心输出量降低的恶性循环，导致包括伴有高钾血症的肾衰竭在内的器官功能障碍，进一步加重心动过缓。它通常与高发病率和高死亡率相关。通常，治疗方法是通过输注儿茶酚胺增加心输出量来增加肾血流量。极少数情况下，可能需要根据具体情况进行诸如静脉输注脂肪乳剂和连续性肾脏替代治疗（CRRT）等干预措施。及时识别BRASH综合征的症状有助于避免诊断延误并降低死亡率。
