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I just got off shift and I need to tell you about this patient. She came in bradycardic, hyperkalemic, hypotensive, and barely making urine. But her potassium wasn’t even that high… and that mismatch is what made me stop. She was on a beta‑blocker. Her kidneys were failing. Her potassium was creeping up. Her blood pressure was dropping. That’s when it clicked: BRASH syndrome. BRASH is a cycle: Bradycardia → Renal failure → AV‑node blockers → Shock → Hyperkalemia. Each piece makes the next one wo
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