Creatinine phosphokinase

Daily gavage of 50, 500, or 2500 pg/kg BW for 102 weeks Dose-related mortality in males during first year and in females during entire study significant lethality in the 500 and 2500 pg/kg groups. No increased incidence of microscopic neoplastic or nonneoplastic lesions in treated rats decreased creatinine phosphokinase levels in treated rats 28... 

After 48 h, marked increase in blood glucose, depressed plasma insulin level, marked depletion of liver glycogen, significant increase in plasma creatinine phosphokinase and glutamic oxaloacetic transaminase activity (Giri etal. 1979)... 

Physical symptoms include dizziness, dysarthria, ataxia, nystagmus, lid ptosis, tachycardia, sweating, and increased deep tendon reflexes. Most subjects show some degree of hypertension, associated with increased minute and tidal volumes of respiration, increased formation of urine, and increased muscle tone. The latter may lead to increased serum creatinine phosphokinase concentration. With very large doses, convulsions and respiratory arrest are the terminal events (11). The course of clinical symptoms and signs following various doses of PCP is shown in Table 2. 

Bradycardia, arrhythmias, and T-wave abnormalities were observed in monkeys exposed to 100 ppm hydrogen cyanide (96 ppm cyanide) for 30 minutes (Purser et al. 1984). Increased cardiac-specific creatinine phosphokinase activity was measured in blood samples from rats 2 hours after 12.5 minutes of exposure to 200 ppm hydrogen cyanide (192 ppm cyanide) for 20 days at 4-day intervals (O Flaherty and Thomas 1982). However, no treatment-related changes were found in the hearts at histopathology. In addition, no cardiovascular effects were reported at necropsy in rats and monkeys exposed to 25 ppm cyanogen (50 ppm cyanide) for 6 months (Lewis et al. 1984). 

Acute inhalation of hydrogen cyanide resulted in bradycardia, arrhythmia, and T-wave abnormalities (Purser et al. 1984), and increased cardiac-specific creatinine phosphokinase activity (O Flaherty and... 

Musculoskeletal Effects. Both patients described by Letz et al. (1984) (see Section 2.2.3.1) had greatly elevated levels of serum creatinine phosphokinase after 1,2-dibromoethane exposure this enzyme increases in the event of skeletal muscle necrosis. There was no report of skeletal muscle being examined at necropsy or histologically in either individual. 

In a 24-year-old man, dermal and inhalation exposure to acrylonitrile resulted in dizziness, flushing, nausea and vomiting. Furthermore, increases in serum creatinine phosphokinase, transaminases and myoglobinuria occurred, possibly as a consequence of tissue hypoxia (Vogel Kirkendall, 1984). 

Following septal ablation, patients should be monitored in a coronary care unit for 24 to 48 hours and the temporary pacing wire should be removed at the end of this period in the absence of atrioventricular block. Patients may then be transferred to a telemetry unit for monitoring of arrhythmias. Total hospitalization is usually for three to five days to monitor for occurrence of complete heart block that would require a permanent pacemaker. A sizeable infarction is induced with alcohol ablation and causes creatinine phosphokinase to peak at 1000 to 1500 one day after the ablation. Patients should be maintained on aspirin indefinitely. 

TMP-SMX = trimethoprim-sulfamethoxazole CSA = cyclosporine TAC = tacrolimus ACEI = ACE inhibitor Rl = renal insufficiency CMV = cytomegalovirus SRL = sirolimus CPK = creatinine phosphokinase enzymes LFTs = liver function tests K+ = potassium Scr = serum creatinine HCT = hematocrit. 

JP-5 Sprague-Dawley rat 24 mL/kg (via oral gavage) 3 days No increase in serum creatinine phosphokinase concentrations was observed Parker et al. 1981... 

Daptomycin is a fermentation product having a cyclic lipopeptide structure. It is primarily active against Gram-positive infections, especially those involved in skin/skin structure infections. It is given IV but must be administered over a period of 30 minutes or more. It binds to cell membranes and causes depolarization, which interrupts protein, DNA, and RNA synthesis. Daptomycin is bactericidal. Although resistance can be achieved in vitro, resistance has been slow to emerge in the clinic. Patients should be monitored for muscle pain or weakness, because some incidence of elevated serum creatinine phosphokinase is associated with its use. A small number of clinical trial patients also developed conditions related to decreases in nerve conduction (e.g., paresthesias and Bell s palsy). Daptomycin is eliminated primarily by the kidney, so dose adjustment may be necessary in cases of renal insufficiency. 

The diagnosis is made by finding hematest-positive urine with tew or no intact red blood cells or an elevated semm creatinine phosphokinase (CPK) level. 

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