Unmasking BRASH Syndrome: A Clinical Challenge in Bradycardia and Renal Dysfunction

The term BRASH refers to a clinical constellation characterized by bradycardia, renal dysfunction, atrioventricular (AV) nodal-blocking medication exposure, shock, and hyperkalemia. Although the condition represents a fully reversible cause of symptomatic bradycardia, it frequently goes unrecognized. Prompt identification and a clear understanding of its underlying mechanisms are essential to avoid unnecessary procedures. The syndrome should be suspected when a patient presents with bradycardia in the setting of impaired kidney function and elevated serum potassium, particularly when there is recent or ongoing use of AV nodal-blocking agents. Early recognition is critical because effective management requires addressing each contributing factor simultaneously, rather than treating a single abnormality in isolation.