{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,11]],"date-time":"2026-04-11T13:36:20Z","timestamp":1775914580204,"version":"3.50.1"},"reference-count":13,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T00:00:00Z","timestamp":1717027200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>BRASH syndrome is a vicious cycle of hyperkalemia and bradycardia and is an under-recognized life-threatening clinical diagnosis. It is usually initiated by hypovolemia or hyperkalemia. We report here on the case of a 92-year-old man with hypertension and heart failure who presented to the emergency department with weakness following diarrhea. He was on amlodipine, benazepril, metoprolol, furosemide and spironolactone. The patient\u2019s blood pressure was 88\/53\u2009mmHg and the serum creatinine was 241\u2009\u03bcmol\/L. Within 2\u2009h, the patient\u2019s heart rate decreased from 58 beats per minute to 26 beats per minute, and serum potassium levels gradually increased from 6.07\u2009mmol\/L to 7.3\u2009mmol\/L. The electrocardiogram showed a junctional escape rhythm with accidental sinus capture. The diagnosis of BRASH syndrome was made based on clinical symptoms, a biochemical profile and the results of an electrocardiogram. The patient was rapidly stabilized with the administration of intravenous calcium gluconate, dextrose and insulin, 5% sodium bicarbonate, 0.9% sodium chloride, furosemide, and oral zirconium cyclosilicate. Sinus rhythm at a heart rate of 75\u2009bpm was detected 5\u2009h later, along with normal serum potassium levels. After 2\u2009weeks, kidney function returned to normal. Clinicians should be alert to patients with hyperkalemia and maintain a high index of suspicion for BRASH syndrome. Timely diagnosis and comprehensive intervention are critical for better outcomes in managing patients with BRASH.<\/jats:p>","DOI":"10.3389\/fmed.2024.1405494","type":"journal-article","created":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T05:11:22Z","timestamp":1717045882000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Case report: A case of bradycardia triggered by diarrhea"],"prefix":"10.3389","volume":"11","author":[{"given":"Meixian","family":"Lei","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuan","family":"Cao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingqing","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huabin","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,5,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1016\/j.ejim.2022.06.002","article-title":"Clinical characteristics of BRASH syndrome: systematic scoping review","volume":"103","author":"Shah","year":"2022","journal-title":"Eur J Intern Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1016\/j.resuscitation.2005.11.002","article-title":"Potassium disorders\u2014clinical spectrum and emergency management","volume":"70","author":"Alfonzo","year":"2006","journal-title":"Resuscitation"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1520","DOI":"10.1007\/s11606-018-4531-6","article-title":"Acute kidney injury due to diarrheal illness requiring hospitalization: data from the National Inpatient Sample","volume":"33","author":"Bradshaw","year":"2018","journal-title":"J Gen Intern Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1016\/j.jemermed.2020.05.001","article-title":"BRASH syndrome: bradycardia, renal failure, AV blockade, shock, and Hyperkalemia","volume":"59","author":"Farkas","year":"2020","journal-title":"J Emerg Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1987.e1","DOI":"10.1016\/j.ajem.2020.05.033","article-title":"Anaphylaxis induced bradycardia, renal failure, AV-nodal blockade, shock, and hyperkalemia: A-BRASH in the emergency department","volume":"38","author":"Flores","year":"2020","journal-title":"Am J Emerg Med"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e065769","DOI":"10.1136\/bmj-2021-065769","article-title":"A tropical electrocardiogram wave","volume":"376","author":"Findlay","year":"2022","journal-title":"BMJ"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"282","DOI":"10.5811\/cpcem.2019.5.43118","article-title":"Trimethoprim\/sulfamethoxazole-induced bradycardia, renal failure, AV-node blockers, shock and Hyperkalemia syndrome","volume":"3","author":"Diribe","year":"2019","journal-title":"Clin Pract Cases Emerg Med"},{"key":"ref8","first-page":"1043","article-title":"Syncope caused by hyperkalemia during use of a combined therapy with the angiotensin-converting enzyme inhibitor and spironolactone","volume":"68","author":"Erden","year":"2010","journal-title":"Kardiol Pol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1186\/s12245-023-00517-w","article-title":"Rare presentation of BRASH syndrome with hypoglycemia and altered mental status. International","volume":"16","author":"Sedl\u00e1k","year":"2023","journal-title":"J Emerg Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"114","DOI":"10.1186\/s12872-024-03782-6","article-title":"BRASH syndrome with a complete heart block- a case report","volume":"24","author":"Gebray","year":"2024","journal-title":"BMC Cardiovasc Disord"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1007\/s10049-019-00667-6","article-title":"Hyperkalemia and BRASH syndrome in emergency medicine: clinical significance and association with ECG findings","volume":"23","author":"Grautoff","year":"2019","journal-title":"Notfall + Rettungsmedizin"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1007\/s11739-020-02452-7","article-title":"The BRASH syndrome: an interaction of bradycardia, renal failure, AV block, shock and hyperkalemia","volume":"16","author":"Schnaubelt","year":"2020","journal-title":"Intern Emerg Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1097\/MEJ.0000000000000762","article-title":"BRASH syndrome \u2013 fact or fiction? A first analysis of the prevalence and relevance of a newly described syndrome","volume":"28","author":"Ravioli","year":"2021","journal-title":"Eur J Emerg Med"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1405494\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,30]],"date-time":"2024-05-30T05:11:32Z","timestamp":1717045892000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1405494\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,30]]},"references-count":13,"alternative-id":["10.3389\/fmed.2024.1405494"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2024.1405494","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,30]]},"article-number":"1405494"}}