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[This article belongs to Volume - 70, Issue - 9]
Published on : 2025-09-11 19:08:21
Article Code: AMJ-11-09-2025-12334
Title : Brash Syndrome: A Rare but Critical Etiology of Bradycardia in the Setting of Acute Kidney Injury
Author(s) : Li Wei, Chen Zhang, Fatima Al-Zahra
Abstract :
The BRASH syndrome is a rare clinical pentad characterised by bradycardia, renal failure, atrioventricular
(AV) blockade, shock and hyperkalaemia. Patients with BRASH syndrome typically present with
bradycardia and hypotension due to the synergistic effect of AV node blocker and hyperkalaemia,
compounded by underlying renal failure. In this report, we present a young patient with a history of
chronic kidney disease and hypertension, who was taking regular beta-blockers and calcium channel
blockers, and presented with persistent dizziness, headache and lethargy, which progressed into
bradycardia and shock. These symptoms were refractory to initial resuscitation, requiring inotropic
support and urgent haemodialysis. The patient was discharged in good condition after initiating regular
dialysis. A high index of suspicion and early recognition are key to managing BRASH syndrome. Standard
advanced cardiac life support algorithms without calcium are generally impractical for BRASH syndrome.
The prognosis for BRASH syndrome is excellent with timely recognition and management.