SHM Converge Scientific Abstract ePoster Gallery-Undifferentiated Circulatory Shock With Bradycardia

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This case describes a 57-year-old man who presented with lethargy, encephalopathy, hypotension, bradycardia, and hypothermia in the setting of acute kidney injury and urinary tract infection. He had a history of hemorrhagic stroke with residual deficits, vascular dementia, hypertension, and recurrent UTIs from obstructive stones, and was taking carvedilol.<br /><br />Laboratory findings showed hyperkalemia, severe azotemia, metabolic acidosis, elevated lactate, leukocytosis, and evidence of E. coli UTI. ECG demonstrated marked sinus bradycardia. The patient was diagnosed clinically with BRASH syndrome, a condition caused by the synergistic interaction of renal failure, hyperkalemia, and AV-nodal blocking medications such as beta-blockers, leading to profound bradycardia and circulatory shock.<br /><br />He was treated with IV fluids, epinephrine infusion, IV calcium, insulin for hyperkalemia, and empiric antibiotics for severe sepsis from complicated UTI. His hemodynamics and renal function improved, and carvedilol was discontinued at discharge and replaced with another antihypertensive.<br /><br />The key message is that BRASH syndrome is an underrecognized but reversible cause of shock, especially in older patients with cardiac or renal disease who take AV-nodal blocking agents. Prompt recognition and treatment can avoid unnecessary pacemaker placement or invasive procedures, and emergent hemodialysis may be needed if hyperkalemia or renal dysfunction is refractory.

Asset Subtitle

Harris Majeed

Meta Tag

Author List Abu Baker Sheikh, Harris Majeed, Tushita Verma

Category Clinical Vignettes

Concept BRASH Syndrome

Concept Bradycardia

Concept Renal Failure

Concept Atrioventricular Blockade

Concept Shock

Distinguished Non-Finalist

Presenter Organization UNM Hospital

Presenting Author Harris Majeed

Track Adult

Keywords

BRASH syndrome

bradycardia

hyperkalemia

acute kidney injury

carvedilol

urinary tract infection

sepsis

circulatory shock

AV-nodal blocker

renal failure

BRASH Syndrome

Bradycardia

Renal Failure

Atrioventricular Blockade

Shock