Zokumasu Koichi, Natori Yuki, Kawakami Masaki
Emergency Medicine, Kanto Central Hospital, Setagaya-Ku, JPN.
Cureus. 2024 Oct 30;16(10):e72731. doi: 10.7759/cureus.72731. eCollection 2024 Oct.
BRASH syndrome, characterized by bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia, is a recently identified syndrome typically caused by the interplay of electrolyte imbalances and medications such as beta-blockers and calcium channel blockers. This report presents the case of a 79-year-old woman with a history of epilepsy and hypertension, managed with carbamazepine, lamotrigine, and antihypertensive medications. She developed BRASH syndrome following reduced fluid intake and worsening renal function. Despite treatment for hyperkalemia and dehydration, she experienced two separate episodes of severe bradycardia, both requiring hospitalization. The second episode was more severe, leading to the placement of a permanent pacemaker. Interestingly, the patient did not exhibit hypotension, which is often associated with BRASH syndrome, highlighting the variability in its presentation. Furthermore, the involvement of antiepileptic drugs like carbamazepine and lamotrigine in this case suggests that BRASH syndrome may not be limited to the effects of cardiovascular medications. This case underscores the importance of early recognition and comprehensive management of BRASH syndrome, particularly in patients taking multiple medications. It also emphasizes the need for further research into the pathophysiology, treatment, and long-term prognosis of this emerging syndrome.
BRASH综合征以心动过缓、肾衰竭、房室结阻滞、休克和高钾血症为特征，是一种最近发现的综合征，通常由电解质失衡与β受体阻滞剂和钙通道阻滞剂等药物相互作用引起。本报告介绍了一名79岁女性的病例，她有癫痫和高血压病史，服用卡马西平、拉莫三嗪和抗高血压药物。在液体摄入量减少和肾功能恶化后，她患上了BRASH综合征。尽管对高钾血症和脱水进行了治疗，但她仍经历了两次严重心动过缓发作，两次均需住院治疗。第二次发作更为严重，导致植入了永久性起搏器。有趣的是，该患者未出现通常与BRASH综合征相关的低血压，这突出了其临床表现的变异性。此外，本病例中卡马西平和拉莫三嗪等抗癫痫药物的参与表明，BRASH综合征可能不限于心血管药物的影响。该病例强调了早期识别和全面管理BRASH综合征的重要性，特别是在服用多种药物的患者中。它还强调了对这种新出现综合征的病理生理学、治疗和长期预后进行进一步研究的必要性。
