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
To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Mild hyperkalemia and low eGFR a tedious recipe for cardiac disaster in the elderly: an unusual reversible cause of syncope and heart block.Heart Int. 2011; 6: e12
- Trimethoprim/sulfamethoxazole-induced bradycardia, renal failure, AV-node blockers, shock and hyperkalemia syndrome.Clin Pract Cases Emergency Med. 2019; 3: 282-285
- Syncope caused by hyperkalemia during use of a combined therapy with the angiotensin-converting enzyme inhibitor and spironolactone.Kardiol Pol. 2010; 68 ([discussion 1046]): 1043-1045
- BRASH syndrome.BMJ Case Rep. 2020; 13
- Anaphylaxis — a 2020 practice parameter update, systematic review and GRADE analysis.J Allergy Clin Immunol. 2020; 145: 1082-1123https://doi.org/10.1016/j.jaci.2020.01.017
- Sinus arrest and moderate hyperkalemia.Ann Cardiol Angeiol (Paris). 2006; 55: 161-163
- Drug-induced hyperkalemia.Am J Med. 2002; 112: 334-335
- Bradycardia induced by hyperkalemia.AAOHN J. 2004; 52: 186-187
- Ranolazine induced bradycardia, renal failure, and hyperkalemia: a BRASH syndrome variant.Case Rep Med. 2019; 20192740617
- Renal impairment, mild hyperkalemia and atrioventricular conduction blockade: a potentially hazardous combination.Int J Biometeorol. 2015; 59: 1545-1546
- Relationship between seasonal weather changes, risk of dehydration, and incidence of severe bradyarrhythmias requiring urgent temporary transvenous cardiac pacing in an elderly population.Int J Biometeorol. 2014; 58: 1513-1520
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.