Abstract
The emergency department (ED) is responsible for managing a variety of acute illnesses
including undifferentiated shock. A newer less recognized syndrome termed BRASH –
bradycardia, renal failure, AV-node blockers, shock and hyperkalemia – is a cycle
of synergy between hyperkalemia and AV-blockade that can result in shock. This entity
is more common amongst the elderly, considering polypharmacy and co-morbid diseases.
Some cases have an inciting trigger of hypovolemia. Anaphylaxis is a potentially lethal
form of shock that most emergency physicians (EP) treat in the ED. The two entities
have never occurred simultaneously. Herein, we report a case of anaphylaxis induced
BRASH syndrome occurring in an elderly diabetic man. The EP should be aware of this
unique presentation of BRASH. It was concluded that the patient's anaphylaxis, caused
hypovolemia, coupled with polypharmacy, and physiological stress, precipitated this
severe form of shock and multi-organ system failure.
Keywords
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Article Info
Publication History
Published online: May 15, 2020
Accepted:
May 8,
2020
Received in revised form:
May 4,
2020
Received:
March 1,
2020
Identification
Copyright
Published by Elsevier Inc.
