A Case of BRASH Syndrome Presenting With Refractory Hyperkalemia Requiring Intermittent Hemodialysis

BRASH syndrome characterized by bradycardia, renal dysfunction, atrioventricular nodal blockade (AVNB), shock, and hyperkalemia presents diagnostic and management challenges due to its complex pathophysiology and varied clinical presentations. We describe a 90-year-old woman with a history of multiple comorbidities who was on beta blockers bisoprolol for heart failure, presented with shock, refractory hyperkalemia along with bradycardia that required intermittent hemodialysis. Initial management involved aggressive hyperkalemia medical therapy and fluid resuscitation, with subsequent consideration of renal replacement therapy hemodialysis following collaboration with a multidisciplinary team, including cardiology and nephrology specialists. Despite aggressive medical management for hyperkalemia, some cases of BRASH syndrome may remain challenging to treat, requiring intermittent hemodialysis highlighting the need for further research and understanding of this complex clinical entity to improve treatment outcomes.