The Interplay of Digoxin and Renal Impairment in BRASH Syndrome: A Case Report on Management Strategies

Abstract

BRASH syndrome (Bradycardia, Renal failure, AV-nodal blockade, Shock, and Hyperkalemia), a frequently underdiagnosed condition, arises from a synergistic, self-perpetuating interaction between atrioventricular-nodal blockers and renal impairment, often initiated by hypovolemia. Management requires a high index of suspicion, focusing on rapid correction of hyperkalemia, fluid resuscitation, and inotropic support. Early recognition is essential; timely, targeted intervention interrupts this vicious cycle and optimizes the clinical prognosis.