Creatinine kinase

Satchell SC, Connaughton M Inappropriate antidiuretic hormone secretion and extreme rises in serum creatinine kinase following MDMA ingestion. Br J Hosp Med 51 495, 1994... 

Davis G., Green M.J. Hill H.A.O. (1986) Detection of ATP and creatinine kinase using an enz>me QlQctrodQ. EnzymeMicrob Tech, 8, 349-352. 

If the test is positive, the urine is examined microscopically for red blood cells. If no red blood cells are found, a tentative diagnosis of myoglobinuria is made, serum chemistries are obtained, and the patient is held to rule out rhabdomyolysis. If the uric acid and creatinine kinase (CK) values are normal, and the patient is asymptomatic, he/she is discharged from the hospital. Routine toxicology tests include urinary PCP, serum alcohol, and hypnotic screen. 

The answer is a. (Hardman, pp 885-8870 Lovastatin should not be used in patients with severe liver disease. With routine use of lovastatin, serum transaminase values may rise, and in such patients the drug may be continued only with great caution. Lovastatin has also been associated with lenticular opacities, and slit-lamp studies should be done before and one year after the start of therapy There is no effect on the otic nerve. The drug is not toxic to the renal system, and reports of bone marrow depression are very rare There is a small incidence of myopathy, and levels of creatinine kinase should be measured when unexplained muscle pain occurs. Combination with cyclosporine or clofibrate has led to myopathy There is no danger in use with bile acid sequestrants. 

Hepatic Effects. Increased serum creatinine and serum creatinine kinase were observed in a man who ingested 0.57 mg CNVkg in a suicide attempt (Saincher et al. 1994). 

Fig. 1. An overview of the DCLD tier/triage flow chart Boxes 1, 2, and 3 are taken from the Office of Device Evaluation decision tree, which is routinely used to determine whether a product can be reviewed as a 510(k) and found substantially equivalent to a predicate (currently marked) device or whether the product must be handled as a fundamentally new product and submitted to a PMA review. Box 4 determines the novelty of the product in terms of analyte, matrix, and/or technology. If new issues of safety and effectiveness are raised, a highly novel product might require review as a PMA. If the issues of safety and effectiveness are not new but require high-level scrutiny, then a tier III review is warranted. Examples of products requiring a tier III review would include 1. Analyte troponin for diagnosis of MI (with creatinine kinase as the predicate) 2. Matrix sweat patches for drugs of abuse (with urine drugs of abuse tests as the predicate) and 3. Technology nucleic acid...

A rare, but potentially fatal idiosyncratic adverse effect is neuroleptic malignant syndrome. This can occur with any antipsychotic drug. The symptoms are rigidity, hyperthermia, autonomic lability, and reduced level of consciousness. Massively elevated levels of creatinine kinase are usually found. Prior to 1984, the mortality rate was around 25% but improved early recognition has considerably reduced this. Management is cessation of antipsychotics, appropriate conservative measures and dantrolene if necessary for muscle rigidity. 

Additional considerations for topically (dermal, intransal, introral, ophthalmic, rectal or vaginal) or pulmonary adminstered excipients are ocular irritation, sensitisation, oral or parenteral route toxicity studies additional considerations for injectable excipients are an in vitro hemolysis study, measurement of creatinine kinase and protein binding evaluation where appropriate new excipients should also be examined for photosafety. 

Bhatt DL, Topol EJ, Cutlip DE, Kuntz RE. Controversies in cardiovascular medicine does creatinine kinase-MB elevation after percutaneous coronary intervention predict outcomes in 2005 Circulation 2005 I 12 906-923. 

Abbreviations-. AA, arachidonic acid AMI, acute myocardial infarction AR, aspirin resistance ASA, aspirin CABG, coronary artery bypass graft surgery CAD, coronary artery disease CK-MB, creatinine kinase-MB CVA, cerebrovascular accident EPI, epinephrine HS, healthy subjects LTA, light transmittance aggregometry mm, millimolar PAR, platelet activity ratio PCI, percutaneous coronary intervention PR, platelet reactivity RPFA, rapid platelet function analyzer TXA2, thromboxane A2. 

Biomarkers help establish the presence of myocardial necrosis. There are nearly two dozen biomarkers currently under study Most experience is with creatinine kinase, creatinine kinase MB, troponin I or 7) and myoglobin, Others are under study (Fig. I) (3). Two other biomarkers currently available are C-reactive protein (CRP) and brain natriuretic peptide (BNP), Even minor elevations of troponin I orT have had prognostic importance, In the tactics TIMI 18 study, troponin levels between 0,1 ng/mL and more than 1,5 ng/mL were found in 60% of the 1821 patients (9), In this study, troponin... 

Creatinine kinase levels should be assessed frequently during the stay in the coronary care unit and may rise up to 1500 U/l. After the procedure there may be some risk... 

Although statins are generally well tolerated, some patients do develop myopathy. This can range from asymptomatic increases in creatinine kinase (CK) to renal failure from rhabdomyolysis. Risk factors include the dose of... 

GSH is involved in the regulation (glutathionylation) of action of several key-enzymes and other proteins (e.g., phosphorylase, creatinine kinase, ras) and in the restoration of the sulfhydryl groups of proteins (maintenance of enzymes and proteins in active form) ... 

In 30 641 patients in 5 major statin trials, myositis (serum creatinine kinase x 10 normal) occurred in 30 (control 29) and rhabdomyolysis in 2 (control 2). Farmer J A 2001 Lancet 358 1383-1385. 

In most patients with chest pain, with or without electrocardiographic changes, the creatinine kinase MB fraction remained normal (10,13,15). 

Of 17 individuals with suspected latent multidrug-resistant tuberculosis treated with pyrazinamide and levofloxacin, 11 developed musculoskeletal adverse effects related to therapy, 5 had nervous system effects, and 15 had raised liver enzymes, uric acid, or creatinine kinase (4). 

The authors suggested that rhabdomyolysis should be considered in patients with myalgia and muscle cramps taking verapamil plus trandolapril, and that routine serum creatinine kinase should be checked (20). 

The lactic acidosis seen with these drugs has ranged from mild and chronic to acute, severe, and fatal [95-106]. The acidosis generally develops after several months of therapy. Patients with NRTl-associated lactic acidosis present with symptoms of nausea, vomiting and abdominal pain. Other features often include elevated liver enzymes, hepatic steatosis, pancreatitis and elevated creatinine kinase with evidence of a myopathy, and liver failure. The lactic acidosis may persist for many weeks despite discontinuation of the NRTl [95-106]. NRTl-related mitochondrial toxicity may also present with rhabdomyolysis and acute kidney failure [110]. Mortality related to NRTl-induced acute lactic acidosis is high, in the range of 50% to 100%, despite drug discontinuation. 

E632 Jensen, A.E., Reikvam, A., NordgSrd, Pedersen, K.G. and Asberg, A. (1990). Diagnostic accuracy of Kodak creatinine kinase MB, Stratus creatine kinase MB, and lactate dehyrogenase isoenzyme 1 in serum after acute myocardial infarction. Clin. Chem. 36, 1847-1848. 

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