Brash syndrome
Background
- Combination of following:
- Bradycardia
- Renal failure
- AV node blocker: beta-blocker, verapamil or diltiazem
- Shock
- Hyperkalemia
- Vicious cycle in setting of medications, hyperkalemia, renal failure
- Renal failure causes hyperkalemia and accumulation of AV node blockers, hyperkalemia synergizes with AV node blockers to cause bradycardia and hypoperfusion, hypoperfusion worsens renal failure [1]
Clinical Features
- Symptoms of bradycardia
- Uremia
- Altered mental status
Differential Diagnosis
- Differential bradycardia
- Differential renal failure
- pure hyperkalemia
- pure AV node blocker intoxication
Evaluation
- Brash syndrome patients can have mild hyperkalemia while pure hyperkalemia to cause bradycardia usually requires more dramatic elevation of potassium level
- ECG findings with bradycardia without other findings of hyperkalemia (QRS widening, peaked T waves) may favor BRASH
Management
Disposition
See Also
External Links
References
- ↑ Hegazi MO, et al. Junctional bradycardia with verapamil in renal failure--care required even with mild hyperkalemia. J Clin PHarm Ther. 2012;37(6):726-8.