BRASH

 Q: BRASH syndrome requires to have EKG demonstration of hyperkalemia? 

A) True

B) False

Answer: B

BRASH syndrome represents a synergistic effect in the body due to 

• Bradycardia
• Renal Failure
• AV blockade
• Shock, and 
• Hyperkalemia

It is common in elderly patients and mostly due to a combination of hyperkalemia and AV nodal blocking drugs such as beta-blockers (BB), calcium channel blockers (CCB), amiodarone, and digoxin. It is common in patients with renal insufficiency. The addition of ACE inhibitors may catalyze this synergism.

It requires a holistic way of treatment by simultaneously managing each component of the syndrome - hyperkalemia, bradycardia, and hypovolemia (renal hypoperfusion). 

These patients may easily deceive a clinician as EKG may or may not have signs of hyperkalemia i.e., peaked T waves and/or QRS prolongation.

#cardiology

#electrolytes

#nephrology

#pharmacology

References:

1. Farkas JD, Long B, Koyfman A, Menson K. BRASH Syndrome: Bradycardia, Renal Failure, AV Blockade, Shock, and Hyperkalemia. J Emerg Med 2020; 59:216.

2. Park DS, Fishman GI. The cardiac conduction system. Circulation 2011; 123:904.