Creatine kinase, serum levels

A 33-year-old female patient treated with haloperidol for a history of schizophrenia is seen in the ED because of complaints of fever, stiffness, and tremor. Her temperature is 104°F, and her serum creatine kinase (CK) level is elevated. What has occurred ... 

Toxicity elevation of serum creatine kinase (CK-MM). In clinical studies (mostly open label), 40% of patients had serum creatine kinase (CK) levels above the upper limit of normal (ULN), and 11% had CK levels that were three times the ULN or more. In cases where CK was fractionated, only the muscle isoenzyme (MM) was elevated. The time to occurrence was sporadic, but the greatest incidence of CK elevation was during the first 2 months of treatment. Elevated CKs were more often seen in males, in patients who were being treated with antidepressants or anti-epileptics, and in patients treated with intrathecal morphine. Most patients who experienced elevations in CK, even for prolonged periods of time, did not have limiting side effects. However, one case of symptomatic myopathy with EMG findings and two cases of acute renal failure associated with rhabdomyolysis and extreme CK elevations (17 000-27 000 lU/L) have been reported. It is recommended that physicians monitor serum CK in patients undergoing treatment with ziconotide periodically. 

Serum creatine kinase (CK) levels variable elevated (less than 10 times normal), but may be normal cardiac troponin (cTn) is often elevated... 

The serum creatine kinase (CK) level is usually mildly elevated and there is rarely more than a 10-fold elevation, but the level may be normal in some cases [8, 27]. It is therefore not helpful diagnostically apart from being an indicator of a myopathic process if it is found to be elevated. 

Constipation occurs in fewer than 10% of patients taking statins. Other adverse effects include elevated serum aminotransferase levels (primarily alanine aminotransferase), elevated creatine kinase levels, myopathy, and rarely rhabdomyolysis. 

Myopathy and neuropathy Colchicine myoneuropathy appears to be a common cause of weakness in patients on standard therapy who have elevated plasma levels caused by altered renal function. It is often unrecognized and misdiagnosed as polymyositis or uremic neuropathy. Proximal weakness and elevated serum creatine kinase are generally present, and resolve in 3 to 4 weeks following drug withdrawal. Maiabsorption of vitamin B-f2- Colchicine induces reversible malabsorption of vitamin B-12, apparently by altering the function of ileal mucosa. 

Hypersensitivity reactions, occasionally fatal, have been reported in 2-5% of patients receiving abacavir. Symptoms, which generally occur within the first 6 weeks of therapy, involve multiple organ systems and include fever, malaise, and gastrointestinal complaints. Skin rash may or may not be present. Laboratory abnormalities such as mildly elevated serum aminotransferase or creatine kinase levels are not specific for this reaction. Although the syndrome tends to resolve quickly with discontinuation of medication, rechallenge with abacavir following discontinuation results in return... 

Other techniques such as serum levels of muscle creatine kinase can also be used to assess dystrophy, but this requires great care in mouse handling. Creatine kinase is released from damaged... 

The patient, a 63-year-old Caucasian female, was hospitalized on 4 April 2002 though 10 April 2002 for a non-ST segment elevation myocardial infarction (non-Q-wave MI per chart documentation). She had a negative adenosine stress test after the initial event. Her serum cardiac-specific troponin I (cTnl) concentration 24 hours after her onset of chest pain was 1.4 pg/L (upper limit of normal is 0.3 ng/mL), and her creatine kinase (CK) MB level was 12.5 pg/L (upper limit of normal 6.0 ng/mL). Three days post-event her cTnl level was 0.5 pg/L and her CK-MB level was 4.5 pg/L (Fig. 5-1). MB refers to one of the isoenzyme forms of CK found in serum. The form of the enzyme that occurs in brain (BB) does not usually get past the blood-brain barrier and therefore is not normally present in the serum. The MM and MB forms account for almost all of the CK in serum. Skeletal muscle contains mainly MM, with less than 2% of its CK in the MB form. MM is also the predominant myocardial creatine kinase and MB accounts for 10%-20% of creatine kinase in heart muscle. 

Why do you think that serum creatine kinase levels might be elevated in patients with seemingly unrelated conditions such as alcoholism and epilepsy ... 

The largest increases in serum creatine kinase occur in this disease, and it has long been recognized that high levels precede the clinical signs of the disease. A close study of the time course of the early changes in several serum enzymes in a single case (H5) revealed an elevation directly after birth, peak levels at 14-22 months, then a slow decline. 

The determination of serum creatine kinase still represents the most valuable method for the detection of the female carriers of Duchenne dystrophy (W7), although a minor proportion of carriers have normal levels of the enzyme. Why this is so is still not clear. Roy and Dubowitz (R13) could find no consistent correlation between serum creatine kinase and histopathological changes in carriers. Possibly some carriers with normal values have a higher rate of inactivation of the enzyme in the blood or of elimination from the circulation much is yet to be learned... 

G14. Griffiths, P. D., Serum levels of ATP-creatine phosphotransferase (creatine kinase). The normal range and effect of muscular activity. Clin. Chim. Acta 13, 413-420 (1966). 

Fig. 17. Typical patterns of Mn-SOD release into serum for two male patients with acute myocardial infarction. (A) A case with an unsuccessful reperfusion (B) successful case. The mean level for normal male adults is almost 100 ng/ml. Other enzymes AST, L-aspartate 2-oxoglutarate ALT, L-alanine 2-oxoglutarate CK, creatine kinase LDH, lactate dehydrogenase.

Muscle cells which arc damaged will leak creatine kina.se into the plasma. This enzyme exists in different isoforms. CK-MM or total CK is used as an index of skeletal mu.scle damage. Very high serum levels may be expected in patients who have been convulsing or have muscular damage due to electrical shock or crush injury. Creatine kinase concentrations may also be high in acute spells in muscular dystrophy. For these rea.sons, when CK is used as an indicator of myocardial infarction. it is better to measure the MB... 

As the TSH is approximately 20 times the upper limit of the reference range and the serum T is significantly decreased, this woman has severe hypothyroidism. Skeletal and cardiac muscles are involved in the hypothyroid process, causing the release of creatine kinase into the circulation. This, combined with a decrease in the catabolic rate of creatine kinase, will be sufficient to cause the creatine kinase to increase to the levels observed in this case. The aspartate aminotransferase is at the upper end of the reference range and this will fall along with the creatine kinase and cholesterol after a few weeks treatment with thyroxine. In view of the evidence of myocardial ischaemia it is prudent to proceed cautiously in this case with a low dose of thyroxine and gradually increase it in a step-wise manner. 

The activity of these enzymes in serum following an Ml is shown in Figure 3. Creatine kinase levels rise rapidly, peaking at 24 h. with slower rises being show ii by A.ST and l.DH. The more rapid fall in CK also allows for its use in the diagnosis of... 

Hypothyroidism results in clinical reports of muscle weakness and fatigue, and observations of enlarged muscle bulk, slowed muscle relaxation, prolonged deep tendon reflexes and elevated serum creatine kinase levels. 

Myoglobinuria. Elevated serum levels of creatine kinase, elevated serum activities of lactate dehydrogenase and aspartate aminotransferase... 

Myoglobinuria. Elevated serum activities of creatine kinase, aspartate aminotransferase, alanine aminotransferase, and lactate dehydrogenase. Increased serum level of light myosin chain. Serum urea and creatinine levels normal... 

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