Rare presentation of BRASH syndrome with hypoglycemia and altered mental status
Dublin Core
Title
Rare presentation of BRASH syndrome with hypoglycemia and altered mental status
Subject
BRASH, Hypoglycemia, Bradycardia, Hyperkalemia
Description
Background BRASH syndrome (bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia)
is a rare clinical condition with potentially severe outcomes. Patients with BRASH syndrome can present with diverse
signs and symptoms and are usually in critical condition, but if recognized early, the syndrome is treatable and may
have a favorable prognosis.
Case presentation This case study presents a 74-year-old patient with a history of multiple chronic conditions who
was brought to the emergency department with a suspected cerebrovascular accident, altered mental status, and
bradycardia. A head computed tomography scan was unremarkable but laboratory results showed hyperkalemia,
acidosis, and renal failure with concomitant progressive hypoglycemia. The patient was diagnosed with a BRASH
syndrome characterized by a vicious cycle of atrioventricular nodal blockade induced by the potentiated effect of
beta-blockers or calcium channel blockers, in combination with progressive hypoglycemia due to the suspected
accumulation of anti-diabetic medications, which influenced the presentation and initial triage in the emergency
department. She was admitted to the intensive care unit for further management, where she continued to improve
and was ultimately discharged in a relatively stable condition.
Conclusion This case study highlights the importance of considering rare and atypical presentations of medical con-
ditions, particularly in elderly patients who may have multiple comorbidities. Early recognition and prompt manage-
ment of such cases are crucial for improving patient outcomes.
is a rare clinical condition with potentially severe outcomes. Patients with BRASH syndrome can present with diverse
signs and symptoms and are usually in critical condition, but if recognized early, the syndrome is treatable and may
have a favorable prognosis.
Case presentation This case study presents a 74-year-old patient with a history of multiple chronic conditions who
was brought to the emergency department with a suspected cerebrovascular accident, altered mental status, and
bradycardia. A head computed tomography scan was unremarkable but laboratory results showed hyperkalemia,
acidosis, and renal failure with concomitant progressive hypoglycemia. The patient was diagnosed with a BRASH
syndrome characterized by a vicious cycle of atrioventricular nodal blockade induced by the potentiated effect of
beta-blockers or calcium channel blockers, in combination with progressive hypoglycemia due to the suspected
accumulation of anti-diabetic medications, which influenced the presentation and initial triage in the emergency
department. She was admitted to the intensive care unit for further management, where she continued to improve
and was ultimately discharged in a relatively stable condition.
Conclusion This case study highlights the importance of considering rare and atypical presentations of medical con-
ditions, particularly in elderly patients who may have multiple comorbidities. Early recognition and prompt manage-
ment of such cases are crucial for improving patient outcomes.
Creator
Marián Sedlák1*, Kamila Brúsiková2
, Vladimíra Sobolová3 and Michal Králik4
, Vladimíra Sobolová3 and Michal Králik4
Source
https://doi.org/10.1186/s12245-023-00517-w
Date
2023
Contributor
Peri Irawan
Format
pdf
Language
english
Type
text
Files
Collection
Citation
Marián Sedlák1*, Kamila Brúsiková2
, Vladimíra Sobolová3 and Michal Králik4, “Rare presentation of BRASH syndrome with hypoglycemia and altered mental status,” Repository Horizon University Indonesia, accessed April 11, 2026, https://repository.horizon.ac.id/items/show/12150.