Abstract
The Journal of the Postgraduate Institute of Medicine (JPGIM) is an open access, peer-reviewed, biannual journal published by the Postgraduate Institute of Medicine (PGIM) of the University of Colombo (UOC), Sri Lanka. The JPGIM aims to publish articles relevant to clinicians, policymakers, and researchers on topics relating to the practice of medicine, medical education, professionalism, integrity, and ethics of the research enterprise. The JPGIM has been in publication since 2014 and publishes accepted manuscripts online immediately after copy-editing, enabling rapid dissemination of scientific knowledge. The published articles are compiled into two issues in June and December.The Journal practices a double-blind peer review policy. The JPIGM does not charge any article processing or publication fee.We recommend that you review the About the Journal page for the journal's section policies, as well as the Submission Guidelines. Authors need to register with the journal prior to submitting or, if already registered, can simply log in and begin the five-step process.
Highlights
Polypharmacy is defined as the concurrent use of an increased number of medications or the use of unnecessary medications
One well described but rare phenomenon associated with polypharmacy is BRASH syndrome which comprises bradycardia, renal impairment, AV blockade, shock and hyperkalemia in a vicious cycle
We report a case of an elderly female on polypharmacy presenting with BRASH syndrome, and lactic acidosis and myocardial ischemia which were linked to one another
Summary
Polypharmacy is defined as the concurrent use of an increased number of medications or the use of unnecessary medications. When admitted to the local hospital, the patient was afebrile and confused with pulse rate of 40/ min and a blood pressure of 100/ 40 mmHg. The ECG was interpreted as nodal bradycardia. On arrival at the National Hospital of Sri Lanka, the patient was confused and pale with a pulse rate of 68/ min and blood pressure of 100/60 mmHg. There was evidence of acute heart failure with bi-basal fine crepitations and an on-air saturation of 88%. The patient later became more confused with evidence of cardiogenic shock, for which she was started on an intravenous noradrenaline infusion. Both medically resistant hyperkalaemia and lactic acidosis warranted urgent hemodialysis after which a marked improvement was observed. Dietary control was advised with the plan for follow up blood sugar measurements
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