Creatine kinase temperature

D.T. Nguyen, M. Smit, B. Dunn, and J.I. Zink, Stabilization of creatine kinase encapsulated in silicate sol-gel materials and unusual temperature effects on its activity. Chem. Mater. 14, 4300-4308 (2002). 

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 ... 

Buist, R. Kroeker, S. Peeling, J. Temperature dependence of the creatine kinase reaction measured in rat brain in vivo by 31P NMR saturation transfer. Can. J. Chem., 77, 1887-1891 (1999)... 

A 30-year-old man who had taken olanzapine 20 mg/ day for 10 days developed typical neuroleptic malignant syndrome with raised body temperature (39.7°C), obtundation, tremor, rigidity, sweating, fluctuating pupillary diameter, tachycardia, labile hypertension, raised serum creatine kinase activity, and severe hypernatremia (190 mmol/1) (108). 

A 30-year-old man with a history of bipolar disorder had substantial weight gain with olanzapine and was switched to risperidone (dose unknown) and lithium carbonate (450 mg bd) (112). A few days later he developed confusion, mild muscle rigidity, a raised temperature, and increased creatine kinase activity. The medications were withdrawn and he responded to supportive therapy. 

A 20-year-old man, a previously healthy student, became agitated within 4 hours of ingesting two tablets of ecstasy at the same rave. His friends reported previous uneventful use of similar amounts. He was comatose and had minimal purposeful movements and a temperature of 41.5°C. His heart rate was 200/minute and his BP 123/57 mmHg. He had hot dry skin and diffuse intermittent myoclonus. Urine toxicology was positive for ecstasy only. His glucose was 2.5 mmol/1 (42 mg/dl), platelets 80 x 109/1, sodium 148 mmol/1, creatinine 186 pmol/l (2.1 mg/dl), and total bilirubin 34 pmol/l (2.0 mg/d peak creatine kinase activity was 17 000 iu/1. He recovered with cooling. 

Figure 9.101 Separation of AMP (1), ADP (2), and ATP (3) for reaction times of (A) 10 minutes, (B) 20 minutes, and (C) 30 minutes using 0.04 jug/mL creatine kinase. Chromatographic conditions column, LiChrosorb C18 flow rate, 2.0 mL/min temperature, ambient detection, UV 254 nm, 0.04 absorbance unit full scale injection volume, 10 imL. (From Danielson and Huth, 1980.)...

A 36-year-old man with paraplegia after a spinal cord injury became disoriented (23). He had marked rigidity in both arms and legs, he was sweating and pyrexial (38°C), and his heart rate was 112/minute. His serum creatine kinase was raised at 2668 U/1 and rose to 2982 U/1 on day 3. At that time, baclofen was restarted. Within 3 days he was fully oriented. Over 2 weeks his creatine kinase activity gradually fell to normal and his temperature settled. It turned out that he had neglected to take any medication for several days before admission. 

Generalized muscle rigidity (found in 70% of the patients involved) and a progressive rise in body temperature (sometimes beyond 43°C) are the main clinical features, often associated with tachycardia, hypoxia, metabolic acidosis, cardiac dysrhythmias and, less often, disseminated intravascular coagulation, cerebral edema, and acute renal insufficiency. Diagnosis relies on the clinical signs, that is muscle rigidity and hyperpyrexia, and on raised serum activities of skeletal and cardiac muscle enzymes, for example aldolase and creatine kinase. 

The reagent strips are packaged in aluminium foils which also contain a drying agent. They can be kept at room temperature, except for the creatine kinase (CK) and the alkaline phosphatase (ALP) test which have to be refrigerated. The shelf-life is one year. 

Szasz, G., W. Gerhardt, and W. Gruber (1978). Creatine kinase in serum 5. Effect of thiols on isoenzyme activity during storage at various temperatures. Clin Chem 24(9) 1557-1563. 

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