Alqawasmi Malik, Escobar Gil Tomas, Shah Ketav, Millhuff Alexandra, Parchim Nicholas
Internal Medicine, University of New Mexico School of Medicine, Albuquerque, USA.
Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, USA.
Cureus. 2025 Jul 9;17(7):e87601. doi: 10.7759/cureus.87601. eCollection 2025 Jul.
Bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia (BRASH) syndrome is defined by the simultaneous presence of its five hallmark features. Despite its potentially severe clinical implications, it is frequently underdiagnosed due to symptom overlap with other conditions. Increased awareness and understanding of this syndrome are essential for prompt diagnosis and effective management, which are key to preventing serious morbidity. A 65-year-old male with a medical history of cirrhosis, portal hypertension, heart failure with reduced ejection fraction, chronic kidney disease, and ventricular bigeminy presented with dizziness and low blood pressure, which had started six to seven days prior. On initial examination, he was found to be bradycardic, with a heart rate in the 30s, and laboratory findings revealed hyperkalemia (6.6 mEq/L) and acute kidney injury (creatinine 2.9 mg/dL). The patient had been on a stable dose of metoprolol, an AV nodal blocking agent, which was recently reduced in the clinic due to worsening renal function. BRASH syndrome was suspected in the ED, prompting initiation of treatment with an epinephrine drip and insulin to address the hyperkalemia. Upon admission to the ICU, cardiac catheterization revealed nonobstructive coronary artery disease. The patient's condition improved over five days, with normalization of potassium levels, restoration of normal sinus rhythm, and resolution of kidney injury, ultimately leading to recovery. At discharge, metoprolol was discontinued, and close cardiology follow-up was arranged. Recognizing BRASH syndrome as a multifaceted clinical entity is critical. Early identification and a comprehensive approach to managing the interdependent components - bradycardia, renal failure, and hyperkalemia - are essential to halt the syndrome's progression and improve patient outcomes.
心动过缓、肾衰竭、房室结阻滞、休克和高钾血症（BRASH）综合征由其五个标志性特征同时出现来定义。尽管其具有潜在的严重临床意义，但由于症状与其他病症重叠，该综合征经常被漏诊。提高对该综合征的认识和理解对于及时诊断和有效管理至关重要，而这是预防严重发病的关键。一名65岁男性，有肝硬化、门静脉高压、射血分数降低的心力衰竭、慢性肾脏病和室性二联律病史，出现头晕和低血压，症状始于六到七天前。初次检查时，发现他心动过缓，心率30多次，实验室检查结果显示高钾血症（6.6 mEq/L）和急性肾损伤（肌酐2.9 mg/dL）。患者一直在服用稳定剂量的美托洛尔，一种房室结阻滞剂，最近因肾功能恶化在门诊减少了剂量。急诊科怀疑为BRASH综合征，于是开始用肾上腺素滴注和胰岛素治疗高钾血症。入住重症监护病房后，心脏导管检查显示为非阻塞性冠状动脉疾病。患者的病情在五天内有所改善，钾水平恢复正常，恢复正常窦性心律，肾损伤得到缓解，最终康复。出院时，停用了美托洛尔，并安排了密切的心脏病学随访。认识到BRASH综合征是一个多方面的临床实体至关重要。早期识别以及对相互关联的组成部分——心动过缓、肾衰竭和高钾血症——进行综合管理，对于阻止该综合征的进展和改善患者预后至关重要。
