Critical presentation of bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia syndrome: A case report.

IF 1 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

World Journal of Clinical Cases Pub Date : 2025-09-06 DOI:10.12998/wjcc.v13.i25.107948

Nicholas Thales Pavlatos, Pawan Daga, Zyad Smiley, Agastya Belur, Priyanka Bhattacharya, Rafay Khan

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引用次数: 0

Abstract

Background: Bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia (BRASH) syndrome is an acronym used to describe a constellation of BRASH. It is an underrecognized phenomenon that can be deadly if not appropriately managed in a timely manner. This case highlights the importance of rapid diagnosis and reviews a multitude of treatment options in a uniquely severe case of BRASH syndrome.

Case summary: We present a case of a 54-year-old male on a beta-blocker and angiotensin-converting enzyme inhibitor who presented with one day history of nausea, vomiting, and shortness of breath. Upon presentation, he was bradycardic and hypotensive, requiring transcutaneous pacing. Initial electrocardiogram showed atrial fibrillation with ventricular rate in 30's. He was found to have acute kidney injury, hyperkalemia, and metabolic acidosis. He was successfully treated with multiple potassium lowering agents, continuous renal replacement therapy, four pressors, mechanical ventilation, and transvenous pacing with complete recovery prior to discharge.

Conclusion: Increased awareness of BRASH syndrome may improve outcomes through timely diagnosis and aggressive intervention.

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心动过缓、肾功能衰竭、房室结阻滞、休克和高钾血症综合征的关键表现：1例报告。

背景：心动过缓、肾功能衰竭、房室结阻滞、休克和高钾血症（BRASH）综合征是用于描述BRASH星座的首字母缩略词。这是一种未得到充分认识的现象，如果不及时加以适当管理，可能会致命。这个病例强调了快速诊断的重要性，并回顾了在一个独特的严重BRASH综合征病例中的多种治疗选择。病例总结：我们报告一例54岁男性，服用β受体阻滞剂和血管紧张素转换酶抑制剂，有一天恶心、呕吐和呼吸短促病史。在就诊时，他是心动过缓和低血压，需要经皮起搏。初始心电图显示心房颤动，心室率30多岁。他被发现有急性肾损伤、高钾血症和代谢性酸中毒。他成功地接受了多种降钾药物、持续肾脏替代疗法、四种降压药、机械通气和经静脉起搏治疗，出院前完全恢复。结论：通过及时诊断和积极干预，提高对BRASH综合征的认识可改善预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World Journal of Clinical Cases Medicine-General Medicine

自引率

0.00%

发文量

3384

期刊介绍： The World Journal of Clinical Cases (WJCC) is a high-quality, peer reviewed, open-access journal. The primary task of WJCC is to rapidly publish high-quality original articles, reviews, editorials, and case reports in the field of clinical cases. In order to promote productive academic communication, the peer review process for the WJCC is transparent; to this end, all published manuscripts are accompanied by the anonymized reviewers’ comments as well as the authors’ responses. The primary aims of the WJCC are to improve diagnostic, therapeutic and preventive modalities and the skills of clinicians and to guide clinical practice in clinical cases.