Alsayed-Ahmad Zein A, Saddour Sanaa, Saddour Tasnim Mustafa, Hariri Mohamad Moafak, Albitar Karam, Albitar Sami
Faculty of Medicine, Aleppo University, Aleppo, Syria.
Faculty of Medicine, Syrian Private University, Damascus, Syria.
Case Rep Nephrol. 2025 May 12;2025:3405566. doi: 10.1155/crin/3405566. eCollection 2025.
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. 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. 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.
BRASH综合征是一种危及生命的疾病，涉及心动过缓、肾衰竭、房室传导阻滞、休克和高钾血症。它通常对传统治疗有抵抗性，需要及时诊断和处理。我们报告一例在急诊科和肾内科成功治疗的BRASH综合征病例。一名患有高血压、糖尿病、缺血性心脏病和慢性肾脏病的57岁男性，出现严重腹泻、嗜睡和休克。他有高钾血症、代谢性酸中毒和急性肾损伤。他的心电图显示窦性心动过缓伴完全性房室传导阻滞。他正在服用比索洛尔，已停药。他接受了血液透析、降钾药物和血管活性药物治疗。他的肾功能改善，心率恢复正常，伴有一度房室传导阻滞。他出院时被建议避免使用房室传导阻滞药物，并接受肾内科和心内科随访。BRASH综合征是肾功能不全和使用房室传导阻滞药物患者高钾血症、低血压和心动过缓的严重并发症。它可能需要血流动力学支持和临时起搏器植入。对该疾病的早期识别和治疗可降低死亡率和发病率。
