What is the clinical evidence from this study?

Study design: Case Report. Population: BRASH syndrome (n=1). Intervention: Medical management of hyperkalemia (calcium chloride, insulin with dextrose, albuterol). Primary outcome: Resolution of bradyarrhythmia and hemodynamic instability.

What question did this study set out to answer?

This research aims to highlight the clinical recognition and management of BRASH syndrome and its symptoms.

April 13, 2026Open Access

Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock, and Hyperkalemia (BRASH) Syndrome: A Deadly Pentad of Symptoms

Key Result

Medical management of hyperkalemia successfully reversed complete heart block and hemodynamic instability in a man in his 70s presenting with BRASH syndrome.

Key Points

This research aims to highlight the clinical recognition and management of BRASH syndrome and its symptoms.
Case report of a man in his 70s with acute symptoms leading to diagnosis.
Evaluation included ECG and laboratory tests for hyperkalemia and kidney injury.
Treatment involved correcting hyperkalemia and using supportive care.
Patient displayed progressive bradycardia and hypotension due to BRASH syndrome.
Hyperkalemia was successfully treated, leading to improvement of bradyarrhythmia.
Emphasis on recognizing the syndrome to prevent severe cardiovascular events.

Study Design

Type

Case Report (n=1)

Multicenter

Structured PICO

Population

A man in his 70s presenting with acute-onset watery diarrhea, syncope, bradycardia, hypotension, hyperkalemia, and acute kidney injury, on home medications including amiloride, carvedilol, and losartan.

Intervention

Medical treatment for hyperkalemia and supportive care

Outcome

Resolution of bradyarrhythmia

This case highlights the importance of early identification and prompt correction of hyperkalemia in BRASH syndrome to reverse bradyarrhythmia and prevent cardiovascular collapse.

Limitations

Single case report limits generalizability
Insufficient data to establish overall epidemiologic frequency of the syndrome

Abstract

Bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia (BRASH) syndrome is an underrecognized clinical entity characterized by a synergistic interplay among hyperkalemia, renal dysfunction, and AV nodal blockade. This self-perpetuating cycle can lead to profound bradycardia and hemodynamic instability if not promptly identified and managed. We report the case of a man in his 70s who presented to the emergency department (ED) with acute-onset watery diarrhea followed by a syncopal episode. On evaluation, he was bradycardic and hypotensive, with laboratory findings notable for hyperkalemia and acute kidney injury. His home medications included amiloride, carvedilol, and losartan. The electrocardiogram (ECG) demonstrated complete heart block. The patient was treated medically for hyperkalemia, with subsequent spontaneous resolution of the bradyarrhythmia. He was diagnosed with BRASH syndrome and admitted to the intensive care unit for further monitoring. In the setting of hyperkalemia and concurrent use of AV nodal blockers, there is a risk of worsening bradycardia and cardiovascular collapse if not recognized early. This case highlights the importance of early identification of BRASH syndrome in patients presenting with bradycardia, particularly those receiving AV nodal blockers. Prompt correction of hyperkalemia and supportive care may reverse the cycle and prevent progression to cardiovascular collapse.

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