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- W4384700517 abstract "The BRASH (bradycardia, renal failure, atrioventricular block, shock and hyperkalaemia) syndrome is a recently recognized condition which may lead to life-threatening complications if not correctly identified and treated early. We report here the case of a 74-year-old woman with type 2 diabetes, hypertension and atrial flutter (treated with apixaban, digoxin, prazosin and telmisartan), who presented to the emergency department with 2-day history of dizziness, pre-syncope and bradycardia, and a junctional rhythm at 61 beat per minute on initial ECG. She was on apixaban, digoxin, prazosin and telmisartan. Serum biochemistry revealed severe hyperkalaemia with a potassium 8.4 mmol/L, creatinine 161 mmol/L, glucose 15.3 mmol/L and an upper normal digoxin level of 1.2 mmol/L (ref. 0.6-1.2). Arterial blood pH was 7.2. Given the constellation of biochemical and clinical findings a diagnosis of BRASH syndrome was made, though her blood pressure values at presentation were rather high (180/65-179/59 mmHg). The patient was rapidly stabilised with the administration of intravenous insulin and dextrose, fluid resuscitation and zirconium cyclosilicate (SZC), followed by haemodialysis. Following the correction of the serum potassium to 4.7 mmol/l, a further ECG performed 6 hours later, showed a restoration of sinus rhythm with a rate of 65 bpm, normalization of the QRS duration. The digoxin and telmisartan were discontinued, and the patient was commenced on a calcium channel antagonist for hypertension. Clinicians should be alerted to patients who present with either a BRASH (shock) or BRAHH (hypertensive manifestation) where timely intervention is essential to avoid life-threatening brady-and tachyarrhythmias in these patients." @default.
- W4384700517 created "2023-07-20" @default.
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- W4384700517 date "2023-11-01" @default.
- W4384700517 modified "2023-09-25" @default.
- W4384700517 title "A BRASH Diagnosis with a Timely Intervention" @default.
- W4384700517 cites W4321766450 @default.
- W4384700517 doi "https://doi.org/10.1016/j.cpcardiol.2023.101984" @default.
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