Open AccessBrugada phenocopy secondary to hyperkalemia and hyponatremia in primary adrenal insufficiency
Author(s) -
Amusina Olga,
Mehta Sandeep,
Nelson Michael E.
Publication year - 2022
Publication title -
journal of the american college of emergency physicians open
Language(s) - English
Resource type - Journals
ISSN - 2688-1152
DOI - 10.1002/emp2.12800
Subject(s) - hyperkalemia , hyponatremia , medicine , phenocopy , brugada syndrome , adrenal insufficiency , hypochloremia , etiology , cardiology , primary adrenal insufficiency , rhabdomyolysis , pediatrics , biochemistry , chemistry , mutant , gene
The Brugada phenocopy represents electrocardiogram (ECG) changes nearly identical to the Brugada syndrome but without the congenital abnormality associated with lethal arrhythmias and normalizes with treatment of the underlying etiology. This case highlights the Brugada phenocopy in the setting of moderate hyperkalemia and severe hyponatremia from adrenal insufficiency that resolves with treatment of the underlying metabolic disturbance. Case Report A 26‐year‐old man with no prior medical history presented to the emergency department with syncope, and his ECG revealed a Brugada‐like pattern. The patient was found to have significant metabolic derangements, including severe hyponatremia (94 mEq/L), moderate hyperkalemia (6.1 mEq/L), severe hypochloremia (<60 mEq/L), acute kidney injury, and rhabdomyolysis. The patient was diagnosed with primary adrenal insufficiency, and electrolyte correction led to resolution of the Brugada phenocopy. Conclusion The Brugada phenocopy on ECG can occur with severe hyponatremia and moderate hyperkalemia and quickly resolves with electrolyte correction.