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Bradycardia, Renal failure, AV nodal blocker, Shock, Hyperkalemia
An inciting event leads to renal failure and hyperkalemia.
Hyperkalemia synergizes with AV nodal blocking medications that leads to the development of bradycardia and shock.
Hypoperfusion causes worsening renal failure and hyperkalemia leading to a vicious cycle that can be deadly without aggressive treatment.
Goals in management
Aggressive blood pressure support
Treatment of hyperkalemia
Remove/treat inciting event
Take home Points
Consider BRASH syndrome in bradycardic patients on AV nodal blockers
Treat hyperkalemia as usual, serum potassium levels may only be mildly elevated, and the ECG may not show classic findings of hyperkalemia
Treat shock aggressively
Remove and treat the underlying cause
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