{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T11:51:41Z","timestamp":1772797901950,"version":"3.50.1"},"reference-count":7,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,2,11]]},"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:p>A 62-year-old woman with chronic kidney disease stage 4, sleep apnoea on continuous positive airway pressure and recent admission for acute-on-chronic diastolic heart failure presented to emergency room with weakness. She was hypotensive and had symptomatic bradycardia in the 30\u2009s secondary to hyperkalaemia and beta-blockers, raising concern for BRASH syndrome. Antihypertensives were immediately held. Potassium-lowering agents (with calcium gluconate for cardiac stability) were begun, as were fluids and dopamine for vasopressor support. The patient was admitted to intensive care unit and electrophysiology was consulted. Over the next 2\u2009days, the patient clinically improved: she remained off dopamine for over 24\u2009hours; potassium levels and renal function improved; and heart rate stabilised in 60\u2009s. The patient was eventually discharged and advised to avoid metolazone, bumetanide and carvedilol, with primary care provider and cardiology follow-up.<\/jats:p>","DOI":"10.1136\/bcr-2019-233825","type":"journal-article","created":{"date-parts":[[2020,2,24]],"date-time":"2020-02-24T05:05:25Z","timestamp":1582520725000},"page":"e233825","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["BRASH syndrome"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5636-7851","authenticated-orcid":false,"given":"Shaurya","family":"Srivastava","sequence":"first","affiliation":[{"name":"College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0714-597X","authenticated-orcid":false,"given":"Tyler","family":"Kemnic","sequence":"additional","affiliation":[{"name":"Department of Medicine, Michigan State University, East Lansing, Michigan, USA"},{"name":"Sparrow Hospital, Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5991-0699","authenticated-orcid":false,"given":"Kyle R","family":"Hildebrandt","sequence":"additional","affiliation":[{"name":"Department of Medicine, Michigan State University, East Lansing, Michigan, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,2,23]]},"reference":[{"key":"2025082801563623000_13.2.e233825.1","unstructured":"Golchin A , Zhou M , Khan A . Bradycardia, Renal Failure, AV-Nodal Blockers, Shock, and Hyperkalemia (BRASH) - A New Clinical Syndrome. ATS Journals 2018;B47."},{"key":"2025082801563623000_13.2.e233825.2","doi-asserted-by":"crossref","unstructured":"Link MS , Berkow LC , Kudenchuk PJ , et al . Adult advanced cardiovascular life support. CPR and first aid, emergency cardiovascular care, 2015. Available: https:\/\/eccguidelines.heart.org\/circulation\/cpr-ecc-guidelines\/part-7-adult-advanced-cardiovascular-life-support\/ [Accessed 31 Jan 2020].","DOI":"10.1161\/CIR.0000000000000261"},{"key":"2025082801563623000_13.2.e233825.3","doi-asserted-by":"crossref","DOI":"10.4081\/hi.2011.e12","article-title":"Mild hyperkalemia and low eGFR a tedious recipe for cardiac disaster in the elderly: an unusual reversible cause of syncope and heart block","volume":"6","author":"Aziz","year":"2011","journal-title":"Heart Int"},{"key":"2025082801563623000_13.2.e233825.4","unstructured":"Farkas J . PulmCrit- BRASH syndrome: bradycardia, renal failure, AV blocker, shock, hyperkalemia. Available: https:\/\/emcrit.org\/pulmcrit\/brash-syndrome-bradycardia-renal-failure-av-blocker-shock-hyperkalemia\/ [Accessed 27 Nov 2019]."},{"key":"2025082801563623000_13.2.e233825.5","doi-asserted-by":"crossref","DOI":"10.1016\/j.chest.2019.08.2152","article-title":"BRASH syndrome: lost in plain sight","volume":"156","author":"Gonuguntla","year":"2019","journal-title":"Chest"},{"key":"2025082801563623000_13.2.e233825.6","doi-asserted-by":"publisher","DOI":"10.1016\/0002-8703(92)91012-P"},{"key":"2025082801563623000_13.2.e233825.7","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.ancard.2005.10.001","article-title":"Sinus arrest and moderate hyperkalemia","volume":"55","author":"Bonvini","year":"2006","journal-title":"Ann Cardiol Angeiol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-233825","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T08:56:49Z","timestamp":1756371409000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-233825"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,2]]},"references-count":7,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,2,23]]},"published-print":{"date-parts":[[2020,2]]}},"alternative-id":["10.1136\/bcr-2019-233825"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-233825","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,2]]}}}