Chui King Wong, Mohd Johar Jaafar

Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia

Keywords: atrioventricular nodal blocker, bradycardia, hyperkalemia, renal failure, shock


BRASH syndrome is a syndrome characterized by bradycardia, renal failure, usage of atrioventricular (AV) nodal blocker, shock, and hyperkalemia (BRASH). It is more common among patients with multiple comorbidities such as cardiac disease, kidney dysfunction, and hypertension requiring AV nodal blockers. Cardiac conduction abnormalities are frequently caused by severe hyperkalemia. However, it may also occur in mild-to-moderate hyperkalemia with concomitant use of AV nodal blockers due to the synergistic effects between these two factors in the presence of renal insufficiency. It is essential for the physician to identify BRASH syndrome as the treatment may differ from standard advanced cardiovascular life support (ACLS) protocol. We report the two cases of patient who presented with BRASH syndrome who failed to respond to standard ACLS protocol.

Author Contributions

WCK contributed to clinical management of the patients, writing of the manuscript, approval of the final draft of the manuscript and corresponding author. MJJ contributed to support of the literature, revision and approval of the final draft of the manuscript.

Conflict of Interest

None Declared

Financial Disclosure