Brash syndrome - Revision history

Blsimpso: /* External Links */

2021-07-01T02:41:55Z

External Links

← Revisión anterior		Revisión del 02:41 1 jul 2021
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	==External Links==		==External Links==
	*https://emcrit.org/pulmcrit/brash-syndrome-bradycardia-renal-failure-av-blocker-shock-hyperkalemia/		*[https://emcrit.org/pulmcrit/brash-syndrome-bradycardia-renal-failure-av-blocker-shock-hyperkalemia/ EMCrit - BRASH Syndrome: Bradycardia, Renal Failure, AV Blocker, Shock, Hyperkalemia]
			*[https://litfl.com/brash-syndrome/ LITFL - BRASH Syndrome]

	==References==		==References==

Athorne: /* Background */

2020-09-09T01:14:33Z

Background

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	**[[Hyperkalemia]]		**[[Hyperkalemia]]
	*Vicious cycle: in setting of medications, hyperkalemia, renal failure		*Vicious cycle: in setting of medications, hyperkalemia, renal failure
			*Often initiated by an episode of hypovolemia, hypoperfusion, or uptitration of antihypertensives or K sparing diuretics
	*Renal failure causes hyperkalemia (+/- accumulation of AV node blockers), hyperkalemia synergizes with AV node blockers to cause bradycardia and hypoperfusion, hypoperfusion worsens renal failure <ref> Hegazi MO, et al. Junctional bradycardia with verapamil in renal failure--care required even with mild hyperkalemia. J Clin PHarm Ther. 2012;37(6):726-8. </ref>		*Renal failure causes hyperkalemia (+/- accumulation of AV node blockers), hyperkalemia synergizes with AV node blockers to cause bradycardia and hypoperfusion, hypoperfusion worsens renal failure <ref> Hegazi MO, et al. Junctional bradycardia with verapamil in renal failure--care required even with mild hyperkalemia. J Clin PHarm Ther. 2012;37(6):726-8. </ref>

Athorne: /* Background */

2020-09-09T01:04:50Z

Background

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	[[File:Brash syndrome.png\|thumb\|via emcrit.org]]		[[File:Brash syndrome.png\|thumb\|via emcrit.org]]
	*Combination of:		*Combination of:
			**[[Bradycardia]]
	**[[Renal failure]]		**[[Renal failure]]
	**AV node blocker: [[beta-blocker]], [[verapamil]] or [[diltiazem]]- typically adherent with medication but an overdose		**AV node blocker: [[beta-blocker]], [[verapamil]] or [[diltiazem]]- typically adherent with medication but an overdose
	**[[Shock]]		**[[Shock]]
	**[[Hyperkalemia]]		**[[Hyperkalemia]]
	**[[Bradycardia]]
	*Vicious cycle: in setting of medications, hyperkalemia, renal failure		*Vicious cycle: in setting of medications, hyperkalemia, renal failure
	*Renal failure causes hyperkalemia (+/- accumulation of AV node blockers), hyperkalemia synergizes with AV node blockers to cause bradycardia and hypoperfusion, hypoperfusion worsens renal failure <ref> Hegazi MO, et al. Junctional bradycardia with verapamil in renal failure--care required even with mild hyperkalemia. J Clin PHarm Ther. 2012;37(6):726-8. </ref>		*Renal failure causes hyperkalemia (+/- accumulation of AV node blockers), hyperkalemia synergizes with AV node blockers to cause bradycardia and hypoperfusion, hypoperfusion worsens renal failure <ref> Hegazi MO, et al. Junctional bradycardia with verapamil in renal failure--care required even with mild hyperkalemia. J Clin PHarm Ther. 2012;37(6):726-8. </ref>

Rossdonaldson1 at 06:15, 28 August 2019

2019-08-28T06:15:26Z

← Revisión anterior		Revisión del 06:15 28 ago 2019
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	==Differential Diagnosis==		==Differential Diagnosis==
	{{Symptomatic bradycardia}}		{{Symptomatic bradycardia}}
	*See [[renal failure]]
	*pure [[hyperkalemia]]
	*pure AV node blocker intoxication (e.g. [[calcium channel blocker toxicity]], [[beta-blocker toxicity]])

	==Evaluation==		==Evaluation==
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	==See Also==		==See Also==
			*[[Renal failure]]
			*Pure [[hyperkalemia]]
			*Pure AV node blocker intoxication (e.g. [[calcium channel blocker toxicity]], [[beta-blocker toxicity]])

	==External Links==		==External Links==
			*https://emcrit.org/pulmcrit/brash-syndrome-bradycardia-renal-failure-av-blocker-shock-hyperkalemia/

	==References==		==References==
	~~https://emcrit.org/pulmcrit/brash-syndrome-bradycardia-renal-failure-av-blocker-shock-hyperkalemia/~~
	<references/>		<references/>

	[[Category:Critical Care]] [[Category:FEN]] [[Category:Cardiology]]		[[Category:Critical Care]] [[Category:FEN]] [[Category:Cardiology]]

Rossdonaldson1 at 06:14, 28 August 2019

2019-08-28T06:14:05Z

← Revisión anterior		Revisión del 06:14 28 ago 2019
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	==See Also==		==See Also==


	==External Links==		==External Links==


	==References==		==References==

Rossdonaldson1: /* Management */

2019-08-28T06:09:11Z

Management

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	==Management==		==Management==
	*Hyperkalemia treatment (e.g. IV [[insulin]]/[[dextrose]], [[albuterol]], IV calcium, kaliuresis or dialysis)		*[[Hyperkalemia]] treatment (e.g. IV [[insulin]]/[[dextrose]], [[albuterol]], IV calcium, kaliuresis or dialysis)
	*[[IVF]] resuscitation for hypovolemia		*[[IVF]] resuscitation for hypovolemia
	*Catecholamines (e.g. [[epinepherine]]) for persistent bradycardia/shock		*Catecholamines (e.g. [[epinepherine]]) for persistent bradycardia/shock

Gregtong: /* Disposition */

2019-08-20T22:51:14Z

Disposition

← Revisión anterior		Revisión del 22:51 20 ago 2019
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	==Disposition==		==Disposition==
			*Admit, typically to ICU setting

	==See Also==		==See Also==

Gregtong: /* Management */

2019-08-20T22:50:36Z

Management

← Revisión anterior		Revisión del 22:50 20 ago 2019
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	*[[IVF]] resuscitation for hypovolemia		*[[IVF]] resuscitation for hypovolemia
	*Catecholamines (e.g. [[epinepherine]]) for persistent bradycardia/shock		*Catecholamines (e.g. [[epinepherine]]) for persistent bradycardia/shock
			*Consider [[isoproterenol]]
	*Targeted treatments for beta-blocker or CCB overdose not helpful		*Targeted treatments for beta-blocker or CCB overdose not helpful
	*May not respond well to [[atropine]] or transcutaneous pacing		*May not respond well to [[atropine]] or transcutaneous pacing
			*Aggressive early diuresis

	==Disposition==		==Disposition==

ClaireLewis at 18:29, 20 August 2019

2019-08-20T18:29:52Z

← Revisión anterior		Revisión del 18:29 20 ago 2019
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	==Background==		==Background==
			[[File:Brash syndrome.png\|thumb\|via emcrit.org]]
	*Combination of:		*Combination of:
	**[[Renal failure]]		**[[Renal failure]]
	**AV node blocker: [[beta-blocker]], [[verapamil]] or [[diltiazem]]		**AV node blocker: [[beta-blocker]], [[verapamil]] or [[diltiazem]]- typically adherent with medication but an overdose
	**[[Shock]]		**[[Shock]]
	**[[Hyperkalemia]]		**[[Hyperkalemia]]
	**Bradycardia		**[[Bradycardia]]
	*Vicious cycle: in setting of medications, hyperkalemia, renal failure		*Vicious cycle: in setting of medications, hyperkalemia, renal failure
	*Renal failure causes hyperkalemia ~~plus~~ accumulation of AV node blockers, hyperkalemia synergizes with AV node blockers to cause bradycardia and hypoperfusion, hypoperfusion worsens renal failure <ref> Hegazi MO, et al. Junctional bradycardia with verapamil in renal failure--care required even with mild hyperkalemia. J Clin PHarm Ther. 2012;37(6):726-8. </ref>		*Renal failure causes hyperkalemia (+/- accumulation of AV node blockers), hyperkalemia synergizes with AV node blockers to cause bradycardia and hypoperfusion, hypoperfusion worsens renal failure <ref> Hegazi MO, et al. Junctional bradycardia with verapamil in renal failure--care required even with mild hyperkalemia. J Clin PHarm Ther. 2012;37(6):726-8. </ref>

	==Clinical Features==		==Clinical Features==
	*Asymptomatic or symptomatic [[bradycardia]]		*Asymptomatic or symptomatic [[bradycardia]]
			**Typically appear more well than vitals/labs suggest
	*Multisystem organ failure ([[shock]], [[pulmonary edema]], [[renal failure]], shock liver)		*Multisystem organ failure ([[shock]], [[pulmonary edema]], [[renal failure]], shock liver)
	*[[Altered mental status]]		*[[Altered mental status]]

	==Differential Diagnosis==		==Differential Diagnosis==
	*Differential bradycardia		{{Symptomatic bradycardia}}
	*~~Differential~~ renal failure		*See [[renal failure]]
	*pure hyperkalemia		*pure [[hyperkalemia]]
	*pure AV node blocker intoxication		*pure AV node blocker intoxication (e.g. [[calcium channel blocker toxicity]], [[beta-blocker toxicity]])

	==Evaluation==		==Evaluation==
	*~~Brash syndrome patients can~~ have mild hyperkalemia ~~while pure hyperkalemia to cause~~ bradycardia ~~usually requires more dramatic elevation~~ of ~~potassium level~~		*May have only mild hyperkalemia, with bradycardia out of proportion to degree of hyperK
	*ECG findings with bradycardia without other findings of ~~hyperkalemia (QRS widening, peaked T waves) may favor BRASH~~		*[[EKG]]: may mot have typical findings of hyperkalemia
	*~~pure AV blocker intoxication may or~~ may ~~not~~ have hyperkalemia~~, need in BRASH. BRASH syndrome patients typically adherent to medications, not usually large ingestion~~

	==Management==		==Management==
	*Hyperkalemia treatment		*Hyperkalemia treatment (e.g. IV [[insulin]]/[[dextrose]], [[albuterol]], IV calcium, kaliuresis or dialysis)
	*~~Fluid~~ resuscitation if hypovolemia		*[[IVF]] resuscitation for hypovolemia
			*Catecholamines (e.g. [[epinepherine]]) for persistent bradycardia/shock
			*Targeted treatments for beta-blocker or CCB overdose not helpful
			*May not respond well to [[atropine]] or transcutaneous pacing
	==Disposition==		==Disposition==

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	==References==		==References==
			https://emcrit.org/pulmcrit/brash-syndrome-bradycardia-renal-failure-av-blocker-shock-hyperkalemia/
	<references/>		<references/>
			[[Category:Critical Care]] [[Category:FEN]] [[Category:Cardiology]]

ClaireLewis at 18:02, 20 August 2019

2019-08-20T18:02:00Z

← Revisión anterior		Revisión del 18:02 20 ago 2019
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	==Background==		==Background==
	*Combination of ~~following~~:		*Combination of:
			**[[Renal failure]]
			**AV node blocker: [[beta-blocker]], [[verapamil]] or [[diltiazem]]
			**[[Shock]]
			**[[Hyperkalemia]]
	**Bradycardia		**Bradycardia
	**Renal failure		*Vicious cycle: in setting of medications, hyperkalemia, renal failure
	**AV node blocker: beta-blocker, verapamil or diltiazem		*Renal failure causes hyperkalemia plus accumulation of AV node blockers, hyperkalemia synergizes with AV node blockers to cause bradycardia and hypoperfusion, hypoperfusion worsens renal failure <ref> Hegazi MO, et al. Junctional bradycardia with verapamil in renal failure--care required even with mild hyperkalemia. J Clin PHarm Ther. 2012;37(6):726-8. </ref>
	**Shock
	**Hyperkalemia
	*Vicious cycle in setting of medications, hyperkalemia, renal failure
	*Renal failure causes hyperkalemia ~~and~~ accumulation of AV node blockers, hyperkalemia synergizes with AV node blockers to cause bradycardia and hypoperfusion, hypoperfusion worsens renal failure <ref> Hegazi MO, et al. Junctional bradycardia with verapamil in renal failure--care required even with mild hyperkalemia. J Clin PHarm Ther. 2012;37(6):726-8. </ref>

	==Clinical Features==		==Clinical Features==
	*Asymptomatic or symptomatic bradycardia		*Asymptomatic or symptomatic [[bradycardia]]
	*Multisystem organ failure (shock, pulmonary edema, renal failure, shock liver)		*Multisystem organ failure ([[shock]], [[pulmonary edema]], [[renal failure]], shock liver)
	*Altered mental status		*[[Altered mental status]]

	==Differential Diagnosis==		==Differential Diagnosis==