BRASH (bradycardia, renal dysfunction, atrioventricular node blockade, shock, and hyperkalemia) syndrome is a recently recognized clinical process that can be fatal if not adequately and promptly treated. As such, it is important for clinicians to recognize the syndrome. This case demonstrates an example of BRASH syndrome in a 73-year-old patient with heart failure occurring after initiation of dapagliflozin, a drug not previously associated with this phenomenon in the literature. Given the increasingly appreciated clinical utility of sodium-glucose cotransporter-2 (SGLT-2) inhibitors, prescribers must respect their potential side effects in patients with underlying comorbidities and remember the importance of re-evaluating renal function after initiation of these medications. Here, we review the pathophysiology of BRASH, the renal effects of SGLT-2 inhibitors, and the importance of educating patients on volume management and diuretic dose titration at home.
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http://dx.doi.org/10.7759/cureus.62830 | DOI Listing |
BRASH syndrome characterized by bradycardia, renal dysfunction, atrioventricular nodal blockade (AVNB), shock, and hyperkalemia presents diagnostic and management challenges due to its complex pathophysiology and varied clinical presentations. We describe a 90-year-old woman with a history of multiple comorbidities who was on beta blockers bisoprolol for heart failure, presented with shock, refractory hyperkalemia along with bradycardia that required intermittent hemodialysis. Initial management involved aggressive hyperkalemia medical therapy and fluid resuscitation, with subsequent consideration of renal replacement therapy hemodialysis following collaboration with a multidisciplinary team, including cardiology and nephrology specialists.
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October 2024
Emergency Medicine, Kanto Central Hospital, Setagaya-Ku, JPN.
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.
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October 2024
Internal Medicine, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Chaves, PRT.
BRASH, an acronym for Bradycardia, Renal failure, AV nodal blockers, Shock, and Hyperkalemia, syndrome is a clinical synergic phenomenon that can result in cardiovascular collapse. We present the case of an 83-year-old woman with dilated cardiomyopathy, heart failure, and chronic kidney disease who was admitted to the emergency room due to syncope and a worsening general condition. The patient was on several medications, including carvedilol, a beta-blocker.
View Article and Find Full Text PDFBRASH syndrome, defined by bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia, is a relatively new and often underrecognized condition. In this article, we present a case of an elderly female who developed an episode of syncope. She was found to have refractory shock and bradycardia in the emergency department.
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June 2024
Department of Internal Medicine, Mount Carmel Health System, Columbus, USA.
BRASH (bradycardia, renal dysfunction, atrioventricular node blockade, shock, and hyperkalemia) syndrome is a recently recognized clinical process that can be fatal if not adequately and promptly treated. As such, it is important for clinicians to recognize the syndrome. This case demonstrates an example of BRASH syndrome in a 73-year-old patient with heart failure occurring after initiation of dapagliflozin, a drug not previously associated with this phenomenon in the literature.
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