Recognizing BRASH syndrome:when minor insults lead to major consequences
Esraa Eltom
Kunal Sareen
Atri Ghosh
Abstract：BRASH syndrome, an acronym for bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia, was first described as a distinct clinical entity in 2016 by Josh Farkas.[1] He proposed a vicious pathophysiological cycle driven by the synergy between AV nodal blockade and hyperkalemia, leading to refractory bradycardia and hypoperfusion-induced prerenal acute kidney injury (AKI).[1,2] Notably, these cascading events may be triggered by relatively mild insults, such as dehydration, infection, and up-titration or overdose of medications or nephrotoxic agents that promote hyperkalemia or renal dysfunction.[3,4] Common culprits include potassium-sparing diuretics, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers, calcium channel blockers and non-specific beta-blockers.
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Publication Date：2025-10-30
Online Publishing Date：2025-11-19(First online date of this platform, not the publication date of the document)
Pages：4( 882-885 )