Why the study?
BRASH syndrome is a rare, potentially life-threatening condition involving AV nodal blocking agents, but its association specifically with amiodarone is not commonly reported.
Amiodarone, an atrioventricular nodal blocking agent, can precipitate BRASH syndrome in the setting of acute kidney injury and hyperkalemia, requiring prompt recognition and discontinuation of the offending agent.
May prompt earlier BRASH consideration in frail elderly on AV blockers; extends sparse case literature but leaves optimal management open.
BRASH [bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia] syndrome is a recently recognized clinical condition that is rare but can be potentially life-threatening. Its pathogenesis is characterized by a self-perpetuating cycle of bradycardia that is potentiated by the concomitant occurrence of medication use, hyperkalemia, and renal failure. AV nodal blocking agents are commonly implicated in BRASH syndrome. We report a case of a 97-year-old female patient with a medical history of heart failure with preserved ejection fraction, atrial fibrillation, hypertension, hyperlipidemia, and hypothyroidism who presented to the emergency department with a one-day history of diarrhea and vomiting. Upon presentation, the patient was hypotensive, bradycardic, and had severe hyperkalemia, acute renal failure, and anion gap metabolic acidosis, raising concern for BRASH syndrome. The treatment of each component of BRASH syndrome resulted in the resolution of the symptoms. The association of BRASH syndrome with amiodarone, the only AV nodal blocking agent in this particular case, is not commonly reported.
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Phuyal et al. (2023) studied this question.
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