BRASH Syndrome: A Patient With Chronic Kidney Disease and AV Nodal Blockers

Background: BRASH syndrome is a life-threatening condition that involves bradycardia, renal failure, atrioventricular blockade, shock, and hyperkalemia. It is often resistant to conventional treatments and requires prompt diagnosis and management. We report a case of BRASH syndrome successfully treated in the Emergency Department and Nephrology Department. Case Presentation: A 57-year-old man with hypertension, diabetes, ischemic heart disease, and chronic kidney disease presented with severe diarrhea, lethargy, and shock. He had hyperkalemia, metabolic acidosis, and acute kidney injury. His electrocardiogram showed sinus bradycardia with complete AV block. He was on bisoprolol, which was discontinued. He received hemodialysis, potassium-lowering agents, and vasoactive drugs. His renal function improved, and his heart rate normalized with first-degree AV block. He was discharged with advice to avoid AV-blocking agents and follow-up with nephrology and cardiology. Conclusions: BRASH syndrome is a serious complication of hyperkalemia, hypotension, and bradycardia in patients with kidney dysfunction and AV-blocking medications. It may require hemodynamic support and temporary pacemaker insertion. Early recognition and treatment of this entity can reduce mortality and morbidity.