The Role of Verapamil Toxicity in the Vicious Cycle of Bradycardia, Renal Failure, Atrioventricular Nodal Blockade, Shock, and Hyperkalemia (BRASH) Syndrome: A Case Report.

BRASH is an acronym describing the vicious cycle seen in patients taking atrioventricular (AV) nodal blockers who tend to present with bradycardia, renal failure, atrioventricular nodal blockade, shock, and hyperkalemia. Herein, we report the case of an 87-year-old hypertensive patient on verapamil who presented with complaints of fever and shortness of breath. She was found to have bradycardia, hyperkalemia, renal impairment, and borderline hypotension. Differentiating this case from previous case reports on BRASH syndrome, this patient was found to simultaneously have toxic levels of serum verapamil.