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

Authors

  • Mahesh Silwal Department of Emergency Medicine, Frontline Hospital, Kathmandu https://orcid.org/0009-0003-1482-7420
  • Alok Kumar Department of General Practice & Emergency Medicine, KIST Medical College Teaching Hospital, Lalitpur
  • Roshan Basnet Department of Emergency Medicine, Frontline Hospital, Kathmandu

Keywords:

Bradycardia, digoxin, hyperkalemia, hypovolemia, renal insufficiency, shock

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.

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Published

2026-10-15

Issue

Vol. 28 No. 3 (2026)

Section

Case Reports

License

Copyright (c) 2026 Nepal Medical College Journal

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

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How to Cite

Silwal, M., Kumar, A., & Basnet, R. (2026). The Interplay of Digoxin and Renal Impairment in BRASH Syndrome: A Case Report on Management Strategies. Nepal Medical College Journal, 28(3), 260-264. https://doi.org/10.3126/nmcj.v28i3.101264