A Case of BRASH Syndrome Required Two Hospitalizations in a Short Period

BRASH syndrome, characterized by bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia, is a recently identified syndrome typically caused by the interplay of electrolyte imbalances and medications such as beta-blockers and calcium channel blockers. This report presents the case of a 79-year-old woman with a history of epilepsy and hypertension, managed with carbamazepine, lamotrigine, and antihypertensive medications. She developed BRASH syndrome following reduced fluid intake and worsening renal function. Despite treatment for hyperkalemia and dehydration, she experienced two separate episodes of severe bradycardia, both requiring hospitalization. The second episode was more severe, leading to the placement of a permanent pacemaker. Interestingly, the patient did not exhibit hypotension, which is often associated with BRASH syndrome, highlighting the variability in its presentation. Furthermore, the involvement of antiepileptic drugs like carbamazepine and lamotrigine in this case suggests that BRASH syndrome may not be limited to the effects of cardiovascular medications. This case underscores the importance of early recognition and comprehensive management of BRASH syndrome, particularly in patients taking multiple medications. It also emphasizes the need for further research into the pathophysiology, treatment, and long-term prognosis of this emerging syndrome.