Episode 991: BRASH
Published: January 19, 2026
Duration: 2:17
Contributor: Aaron Lessen, MD
Educational Pearls
BRASH Syndrome:
Bradycardia
Renal Failure
AV Nodal Blockade
Shock
Hyperkalemia
Clinical Features:
Profound bradycardia and shock in patients on AV nodal blockers:
Commonly, Beta Blockers or Calcium Channel Blockers
Etiology:
Caused by an inciting kidney injury:
Common triggers include precipitating illness, dehydration, or medications
Results in hyperkalemia
The enhanced effect of the combination of AV nodal blockade and hyperkalemia leads to a more pro...