{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T10:22:00Z","timestamp":1790504520979,"version":"4.1.0"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T00:00:00Z","timestamp":1708300800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T00:00:00Z","timestamp":1708300800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Cardiovasc Disord"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>BRASH syndrome (Bradycardia, Renal failure, Atrioventricular (AV) nodal blocking agent, Shock and Hyperkalemia) is a recently emerging diagnosis that describes the profound bradycardia seen in patients on AV nodal blockers who present with acute kidney injury (AKI) and hyperkalemia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We present a case of a 68\u2009years old female patient with past history of hypertension taking atenolol and Enalapril presented to emergency department with the complaint of loss of consciousness of 02\u2009hours duration. She had 03\u2009days history of fatigue, poor oral intake, decreased urine output, appetite loss, vertigo and global headache. Her vital signs were blood pressure of 60\/40\u2009mmHg, absent radial pulse and temperature of 36.4\u2009\u00b0C. Her systemic examination was remarkable for dry buccal mucosa; apical heart rate was 22 beats per minute. Glasgow Coma Scale was 13\/15. Her laboratory tests showed creatinine of 1.83\u2009mg\/dL, blood urea nitrogen of 89\u2009mg\/dL and potassium elevated to the level of 6.39\u2009mEq\/dL. ECG revealed complete heart block with a normal QT interval and T waves and no U waves with ventricular rate of 22 beats per minute. Her previous medications were discontinued and the patient was resuscitated with intravenous (IV) fluids. She was given 03 doses of 1\u2009mg atropine every 5\u2009minutes but there was no increment in heart rate. She was given 50% dextrose with 10 international units of regular insulin, 1\u2009g of calcium gluconate and Intravenous perfusion of norepinephrine and dopamine. Subsequently, after 14\u2009hours of ICU admission the patient had a cardiac arrest with asystole and resuscitation was attempted but she couldn\u2019t survive.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>BRASH syndrome is largely an under-recognized life threatening clinical diagnosis. Physicians should have high index of suspicion for BRASH when they encounter patients with bradycardia, hyperkalemia, and renal failure, as timely diagnosis is crucial in the management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12872-024-03782-6","type":"journal-article","created":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T09:02:53Z","timestamp":1708333373000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["BRASH syndrome with a complete heart block- a case report"],"prefix":"10.1186","volume":"24","author":[{"given":"Habtamu Mesele","family":"Gebray","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abirham Eneyew","family":"Abeje","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abayneh Tunta","family":"Boye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,19]]},"reference":[{"issue":"2","key":"3782_CR1","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1016\/j.jemermed.2020.05.001","volume":"59","author":"D Farkas Joshua","year":"2020","unstructured":"Farkas Joshua D, ea. BRASH syndrome: bradycardia, renal failure, AV blockade, shock, and hyperkalemia. J Emerg Med. 2020;59(2):216\u201323.","journal-title":"J Emerg Med."},{"key":"3782_CR2","doi-asserted-by":"publisher","unstructured":"Shah P, Gozun M, Keitoku K, Kimura N, Yeo J, Czech T, Nishimura Y. Clinical characteristics of BRASH syndrome: systematic scoping review. Eur J Int Med. 2022;103:57\u201361. https:\/\/doi.org\/10.1016\/j.emjim.2022.06.002.","DOI":"10.1016\/j.emjim.2022.06.002"},{"key":"3782_CR3","doi-asserted-by":"crossref","unstructured":"Saini TRJ, Al Hennawi H, Cox A, Janga C, DeLiana D, McCaffrey J. The vicious cycle of BRASH syndrome: A case report. Glob Cardiol Sci Practice. 2023:2.","DOI":"10.21542\/gcsp.2023.2"},{"key":"3782_CR4","doi-asserted-by":"crossref","unstructured":"Harris Majeed UK, Amin Moazzam Kan. BRASH syndrome: A systematic review of reported cases current problems in Cardiology june 2023;48(6).","DOI":"10.1016\/j.cpcardiol.2023.101663"},{"key":"3782_CR5","first-page":"42","volume":"16","author":"KB Mari\u00e1n Sedl\u00e1k","year":"2023","unstructured":"Mari\u00e1n Sedl\u00e1k KB, Sobolov\u00e1 V, Kr\u00e1lik M. Rare presentation of BRASH syndrome with hypoglycemia and altered mental status. International. J Emerg Med. 2023;16:42.","journal-title":"J Emerg Med."},{"key":"3782_CR6","first-page":"e934600","volume":"23","author":"JJ Bailuni Neto","year":"2022","unstructured":"Bailuni Neto JJ, Siqueira BL, Machado FC, Boros GAB. BRASH syndrome: a case report. Am J Case Rep. 2022;23:e934600.","journal-title":"Am J Case Rep."},{"key":"3782_CR7","doi-asserted-by":"crossref","unstructured":"Rabia Mahmood AM. A case of BRASH syndrome in an elderly female with acute urinary retention. Cureus. 2023:15.","DOI":"10.7759\/cureus.36803"},{"key":"3782_CR8","doi-asserted-by":"crossref","unstructured":"Steven Imburgio AJ, Ndausung Udongwo, Anton Mararenko, Anas Alrefaee and Joseph Heaton. BRASH Syndrome: A Case Report and Literature Review. J Integr Cardiol. 2022.","DOI":"10.31487\/j.JICOA.2022.03.05"},{"key":"3782_CR9","first-page":"128","volume":"4","author":"MRD Mogamat-Yazied Chothia","year":"2020","unstructured":"Mogamat-Yazied Chothia MRD. BRASH syndrome: an emerging emergency. PAMJ Clin Med. 2020;4:128.","journal-title":"PAMJ Clin Med."},{"key":"3782_CR10","doi-asserted-by":"crossref","unstructured":"Jasti J R JT, Gudiwada M, et al.. Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock and Hyperkalemia (BRASH) Syndrome: A Clinical Case Study. . Cureus. February 09, 2023;15(2).","DOI":"10.7759\/cureus.34803"}],"container-title":["BMC Cardiovascular Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-024-03782-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12872-024-03782-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12872-024-03782-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,19]],"date-time":"2024-02-19T09:03:44Z","timestamp":1708333424000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmccardiovascdisord.biomedcentral.com\/articles\/10.1186\/s12872-024-03782-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,19]]},"references-count":10,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["3782"],"URL":"https:\/\/doi.org\/10.1186\/s12872-024-03782-6","relation":{},"ISSN":["1471-2261"],"issn-type":[{"value":"1471-2261","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,19]]},"assertion":[{"value":"14 January 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 February 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"19 February 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed consent was obtained from the family of the patient since our patient was in a state of impaired mental status.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publication"}},{"value":"Ethical clearance was obtained from the ethical committee of Weldia Comprehensive Specialized Hospital and consent was obtained from the family of our patient to prepare the case for case report.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"114"}}