{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T15:36:57Z","timestamp":1768923417169,"version":"3.49.0"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,6,9]],"date-time":"2024-06-09T00:00:00Z","timestamp":1717891200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,6,9]],"date-time":"2024-06-09T00:00:00Z","timestamp":1717891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100007052","name":"Universit\u00e0 degli Studi di Verona","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007052","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Bradycardia, renal failure, atrioventricular (AV) node blocking, shock, and hyperkalemia syndrome is a potentially life-threatening clinical condition characterized by bradycardia, renal failure, atrioventricular (AV) node blocking, shock, and hyperkalemia. It constitutes a vicious circle in which the accumulation of pharmacologically active compounds and hyperkalemia lead to hemodynamic instability and heart failure.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 66-year-old Caucasian female patient was admitted to the emergency department presenting with fatigue and bradycardia. Upon examination, the patient was found to be anuric and hypotensive. Laboratory investigations revealed metabolic acidosis and hyperkalemia. Clinical evaluation suggested signs of digoxin toxicity, with serum digoxin concentrations persistently elevated over several days. Despite the implementation of antikalemic measures, the patient\u2019s condition remained refractory, necessitating renal dialysis and administration of digoxin immune fab.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Bradycardia, renal failure, atrioventricular (AV) node blocking, shock, and hyperkalemia syndrome is a life-threatening condition that requires prompt management. It is important to also consider potential coexisting clinical manifestations indicative of intoxication from other pharmacological agents. Specifically, symptoms associated with the accumulation of drugs eliminated via the kidneys, such as digoxin. These manifestations may warrant targeted therapeutic measures.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13256-024-04600-5","type":"journal-article","created":{"date-parts":[[2024,6,9]],"date-time":"2024-06-09T00:02:03Z","timestamp":1717891323000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Not only Van Gogh: a case of BRASH syndrome with concomitant digoxin toxicity"],"prefix":"10.1186","volume":"18","author":[{"given":"Ilaria","family":"Costantini","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Mantelli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6523-6036","authenticated-orcid":false,"given":"Massimo","family":"Carollo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorenzo","family":"Losso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elia","family":"Morando","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matilde","family":"Bacchion","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariapaola","family":"Castri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lucia","family":"Drezza","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giorgio","family":"Ricci","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,6,9]]},"reference":[{"issue":"2","key":"4600_CR1","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1016\/j.jemermed.2020.05.001","volume":"59","author":"JD Farkas","year":"2020","unstructured":"Farkas JD, Long B, Koyfman A, Menson K. BRASH syndrome: bradycardia, renal failure, AV blockade, shock, and hyperkalemia. J Emerg Med. 2020;59(2):216\u201323. https:\/\/doi.org\/10.1016\/j.jemermed.2020.05.001.","journal-title":"J Emerg Med"},{"issue":"2","key":"4600_CR2","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1097\/MEJ.0000000000000762","volume":"28","author":"S Ravioli","year":"2021","unstructured":"Ravioli S, Woitok BK, Lindner G. BRASH syndrome\u2014fact or fiction? A first analysis of the prevalence and relevance of a newly described syndrome. Eur J Emerg Med. 2021;28(2):153\u20135. https:\/\/doi.org\/10.1097\/MEJ.0000000000000762.","journal-title":"Eur J Emerg Med"},{"key":"4600_CR3","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.ejim.2022.06.002","volume":"103","author":"P Shah","year":"2022","unstructured":"Shah P, Gozun M, Keitoku K, et al. Clinical characteristics of BRASH syndrome: systematic scoping review. 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A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"273"}}