{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T13:36:21Z","timestamp":1775914581314,"version":"3.50.1"},"reference-count":5,"publisher":"SMC Media","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia (BRASH) syndrome is a relatively new clinical entity. It is often underrecognized, underdiagnosed, and confused with other causes of bradycardia. Treatment of BRASH syndrome differs from the standard bradycardia algorithm in advanced cardiac life support (ACLS), and the cornerstone management remains treating the hyperkalemia, improving renal function by treating the underlying cause, withholding AV nodal blocking agents, and considering dialysis in refractory cases, as any single factor could precipitate the vicious cycle. Here we describe two cases of BRASH syndrome with different clinical presentations that were treated with conservative management: one case in a 77-year-old Japanese woman and the other in an 86-year-old man.<\/jats:p>","DOI":"10.12890\/2022_003314","type":"journal-article","created":{"date-parts":[[2022,4,8]],"date-time":"2022-04-08T03:44:51Z","timestamp":1649389491000},"source":"Crossref","is-referenced-by-count":12,"title":["Two Cases of BRASH Syndrome: A Diagnostic Challenge"],"prefix":"10.12890","volume":"9","author":[{"given":"Parthav","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Medicine, John A. Burns School of Medicine, University of Hawai\u2018i at M\u0101noa, Honolulu, Hawaii, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krixie","family":"Silangcruz","sequence":"additional","affiliation":[{"name":"Department of Medicine, John A. Burns School of Medicine, University of Hawai\u2018i at M\u0101noa, Honolulu, Hawaii, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Medicine, John A. Burns School of Medicine, University of Hawai\u2018i at M\u0101noa, Honolulu, Hawaii, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshito","family":"Nishimura","sequence":"additional","affiliation":[{"name":"Department of Medicine, John A. Burns School of Medicine, University of Hawai\u2018i at M\u0101noa, Honolulu, Hawaii, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10397","published-online":{"date-parts":[[2022,4,8]]},"reference":[{"key":"10.12890\/2022_003314_ref1","doi-asserted-by":"crossref","unstructured":"<li>Farkas JD, Long B, Koyfman A, Menson K. BRASH syndrome: bradycardia, renal failure, AV blockade, shock, and hyperkalemia. <em>J Emerg Med<\/em> 2020;<strong>59<\/strong>(2):216\u2013223.<\/li>","DOI":"10.1016\/j.jemermed.2020.05.001"},{"key":"10.12890\/2022_003314_ref2","doi-asserted-by":"crossref","unstructured":"<li>Grautoff S, Holtz L. Hyperkalemia and BRASH syndrome in emergency medicine: clinical significance and association with ECG findings. <em>Notf Rett Med<\/em> 2020;<strong>23<\/strong>(3):172\u2013179.<\/li>","DOI":"10.1007\/s10049-019-00667-6"},{"key":"10.12890\/2022_003314_ref3","doi-asserted-by":"crossref","unstructured":"<li>Arif AW, Khan MS, Masri A, Mba B, Talha Ayub M, Doukky R. BRASH syndrome with hyperkalemia: an under-recognized clinical condition. <em>Methodist Debakey Cardiovasc J<\/em> 2020;<strong>16<\/strong>3):241\u2013244.<\/li>","DOI":"10.14797\/mdcj-16-3-241"},{"key":"10.12890\/2022_003314_ref4","doi-asserted-by":"crossref","unstructured":"<li>Srivastava S, Kemnic T, Hildebrandt KR. BRASH syndrome. <em>BMJ Case Rep<\/em> 2020;<strong>13<\/strong>(2):e233825.<\/li>","DOI":"10.1136\/bcr-2019-233825"},{"key":"10.12890\/2022_003314_ref5","doi-asserted-by":"crossref","unstructured":"<li>Grigorov MV, Belur AD, Otero D, Chaudhary S, Grigorov E, Ghafghazi S. The BRASH syndrome, a synergistic arrhythmia phenomenon. Proc (Bayl Univ Med Cent) 2020;33(4):668\u2013670.<\/li>","DOI":"10.1080\/08998280.2020.1784637"}],"container-title":["European Journal of Case Reports in Internal Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/3314\/3090","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/3314\/3091","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/download\/3314\/3091","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T10:50:02Z","timestamp":1755859802000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ejcrim.com\/index.php\/EJCRIM\/article\/view\/3314"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,8]]},"references-count":5,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.12890\/2022_003314","relation":{"has-manifestation":[{"id-type":"other","id":"1-84-3314-g3090","asserted-by":"subject"},{"id-type":"other","id":"1-84-3314-g3091","asserted-by":"subject"}],"is-part-of":[{"id-type":"other","id":"1-84","asserted-by":"subject"}]},"ISSN":["2284-2594"],"issn-type":[{"value":"2284-2594","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,8]]},"article-number":"8"}}