{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T07:00:36Z","timestamp":1764745236538,"version":"3.46.0"},"reference-count":9,"publisher":"Touch Medical Media, Ltd.","issue":"1","license":[{"start":{"date-parts":[[2018,2,16]],"date-time":"2018-02-16T00:00:00Z","timestamp":1518739200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"This article is published under the Creative Commons Attribution Non-commercial License."}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023]]},"abstract":"<p>Bradycardia, renal failure, atrioventricular nodal blockade, shock and hyperkalemia (BRASH) syndrome is named after the pentad of symptoms experienced by patients with this clinical entity, and is propagated via a synergistic mechanism. Herein, we describe a case of an 81-year-old male who presented with bradycardia, dyspnoea on exertion, and confusion. He was also initially found to be in cardiogenic shock. In a setting of elevated digoxin levels, acute renal failure and hyperkalemia, he was diagnosed with BRASH syndrome. Prompt interventions of continuous renal replacement therapy and digoxin antibody administration were performed to treat this patient. His renal function improved and his hyperkalemia and bradycardia resolved over the course of 4 days, and the patient was discharged to a subacute rehabilitation facility after stabilization. BRASH syndrome is a clinical entity requiring prompt diagnosis for life-saving treatment, including renal replacement therapy, vasoactive medications, transvenous pacing, and reversing agents, when appropriate.<\/p>","DOI":"10.17925\/hi.2023.17.1.60","type":"journal-article","created":{"date-parts":[[2023,7,1]],"date-time":"2023-07-01T10:16:28Z","timestamp":1688206588000},"page":"60","source":"Crossref","is-referenced-by-count":6,"title":["Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock and Hyperkalaemia Syndrome Involving Digoxin Toxicity: A Case Report"],"prefix":"10.17925","volume":"17","author":[{"given":"Meet","family":"Shah","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arthi","family":"Palani","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ashkan","family":"Hashemi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaewook","family":"Shin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"7274","reference":[{"key":"ref1","unstructured":"Lizyness K, Dewald O. BRASH syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, 2022. Available at: www.ncbi.nlm.nih.gov\/books\/NBK570643"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Arif AW, Khan MS, Masri A, et al. BRASH syndrome with hyperkalemia: An under-recognized clinical condition.\n                      Methodist Debakey Cardiovasc J\n                      . 2020;16:241\u20134. DOI: 10.14797\/mdcj-16-3-241","DOI":"10.14797\/mdcj-16-3-241"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Farkas JD, Long B, Koyfman A, Menson K. BRASH syndrome: Bradycardia, renal failure, AV blockade, shock, and hyperkalemia.\n                      J Emerg Med\n                      . 2020;59:216\u201323. DOI: 10.1016\/j. jemermed.2020.05.001","DOI":"10.1016\/j.jemermed.2020.05.001"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Shah P, Gozun M, Keitoku K, et al. Clinical characteristics of BRASH syndrome: Systematic scoping review.\n                      Eur J Intern Med\n                      . 2022;103:57\u201361. DOI: 10.1016\/j.ejim.2022.06.002","DOI":"10.1016\/j.ejim.2022.06.002"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Al-Khafaji M, Al-Salem IH. Nifedipine induced bradycardia in a patient with autonomic neuropathy.\n                      Jpn Heart J\n                      . 1989;30:679\u201383. DOI: 10.1536\/ihj.30.679","DOI":"10.1536\/ihj.30.679"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Simmons T, Blazar E. Synergistic bradycardia from beta blockers, hyperkalemia, and renal failure.\n                      J Emerg Med\n                      . 2019;57:e41\u20134. DOI: 10.1016\/j.jemermed.2019.03.039","DOI":"10.1016\/j.jemermed.2019.03.039"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Srivastava S, Kemnic T, Hildebrandt KR. BRASH syndrome.\n                      BMJ Case Rep\n                      . 2020;13:e233825. DOI: 10.1136\/bcr-2019-233825.","DOI":"10.1136\/bcr-2019-233825"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Majeed H, Khan U, Khan AM, et al. BRASH syndrome: A systematic review of reported cases.\n                      Curr Probl Cardiol\n                      . 2023;48:101663. DOI: 10.1016\/j.cpcardiol.2023.101663.","DOI":"10.1016\/j.cpcardiol.2023.101663"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Bailuni Neto JJ, Siqueira B de L, Machado FC, et al. BRASH syndrome: A case report.\n                      Am J Case Rep\n                      . 2022;23:e934600. DOI: 10.12659\/AJCR.934600.","DOI":"10.12659\/AJCR.934600"}],"container-title":["Heart International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/touchcardio.com\/arrhythmia\/journal-articles\/bradycardia-renal-failure-atrioventricular-nodal-blockade-shock-and-hyperkalaemia-syndrome-involving-digoxin-toxicity-a-case-report\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T06:58:12Z","timestamp":1764745092000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.touchcardio.com\/arrhythmia\/journal-articles\/bradycardia-renal-failure-atrioventricular-nodal-blockade-shock-and-hyperkalaemia-syndrome-involving-digoxin-toxicity-a-case-report\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023]]},"references-count":9,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023]]}},"alternative-id":["HI.2023.17.1.60"],"URL":"https:\/\/doi.org\/10.17925\/hi.2023.17.1.60","relation":{},"ISSN":["2036-2579"],"issn-type":[{"type":"print","value":"2036-2579"}],"subject":[],"published":{"date-parts":[[2023]]}}}