Episode 991: BRASH
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Episode 991: BRASH
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Contributor: Aaron Lessen, MD
Educational Pearls
BRASH Syndrome:
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Bradycardia
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Renal Failure
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AV Nodal Blockade
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Shock
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Hyperkalemia
Clinical Features:
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Profound bradycardia and shock in patients on AV nodal blockers:
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Commonly, Beta Blockers or Calcium Channel Blockers
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Etiology:
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Caused by an inciting kidney injury:
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Common triggers include precipitating illness, dehydration, or medications
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Results in hyperkalemia
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The enhanced effect of the combination of AV nodal blockade and hyperkalemia leads to a more profound presentation of shock.
Treatment:
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IV Fluids, unless volume overloaded
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Epinephrine for bradycardia
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Lasix for volume overload, only if the patient is still making urine
- Low threshold to dialyze for hyperkalemia
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Focus on treating early and more aggressively.
References:
Farkas JD, Long B, Koyfman A, Menson K. BRASH Syndrome: Bradycardia, Renal Failure, AV Blockade, Shock, and Hyperkalemia. J Emerg Med. 2020 Aug;59(2):216-223. doi: 10.1016/j.jemermed.2020.05.001. Epub 2020 Jun 18. PMID: 32565167.
Summarized by Ashley Lyons OMS3
Editting by Ashley Lyons OMS3 and Jeffrey Olson MS4
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