Bradycardia, Renal Failure, Atrioventricular Block, Shock, and Hyperkalemia (BRASH) Syndrome Emergence in a Unique Intersection of COVID-19 and End-Stage Renal Disease: A Case Report.

Publication date: Feb 01, 2024

Bradycardia, renal failure, atrioventricular (AV) block, shock, and hyperkalemia (BRASH) syndrome is a rare clinical entity that poses challenges for healthcare practitioners. It is characterized by bradycardia, renal failure, atrioventricular (AV) obstruction, shock, and hyperkalemia. This case is an interesting instance of BRASH syndrome in the setting of COVID-19 infection and end-stage renal disease (ESRD). Initial laboratory results revealed macrocytic anemia, renal dysfunction, acidosis, and mild hyponatremia, along with hyperkalemia. An electrocardiogram (EKG) and telemonitoring showed dopamine-resistant persistent bradycardia until transvenous temporary pacemaker placement was done, which resolved the bradycardia. Anti-hyperkalemic therapy, avoiding AV nodal-blocking medication, and temporary pacemaker placement were all part of the management. After receiving hemodialysis, the patient gradually recovered. Bradycardia improved and potassium normalized. The intricate interaction between hyperkalemia and AV nodal obstruction that causes BRASH syndrome results in severe bradycardia and shock. To the best of our knowledge, this is the first case of BRASH syndrome in a patient with an active COVID-19 infection in a previously vaccinated patient. Even though case reports make up the majority of the material currently in publication, to fully comprehend the mechanisms underlying this illness, more research is required, as early detection of this syndrome is crucial for better patient outcomes.

Concepts Keywords
Bradycardia beta blockers
Covid bradycardia
Hemodialysis brash syndrome
Potassium covid-19 infection
Severe heart block


Type Source Name
disease MESH Bradycardia
disease MESH Renal Failure
disease MESH Atrioventricular Block
disease MESH Shock
disease MESH Hyperkalemia
disease MESH Syndrome
disease MESH COVID-19
disease MESH End-Stage Renal Disease
disease VO report
disease IDO entity
disease MESH infection
disease MESH macrocytic anemia
disease MESH acidosis
disease MESH hyponatremia
drug DRUGBANK Dopamine
drug DRUGBANK Potassium
disease MESH causes
disease VO vaccinated
disease VO publication
drug DRUGBANK Tropicamide
disease MESH heart block

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