If it is a GSH deficiency, will be indicated by undetectable GGT
levels as it supplies the substrate for GSH. What is the GGT level in
this patient?
Regards
Vivek
Guy's & St.Thomas'
On Tue, 14 Nov 2000, Peter Vervaart wrote:
> There was a recent paper in Clin Chem (sorry haven't got the reference)
> showing that CK levels can fall rapidly to quite low levels in severe
> glutathione deficiency due to oxidation of thiol groups in CK and thus loss
> of activity. The paper suggested that the NAC found in most assay systems is
> insufficient to 'restore' the CK activity when this occurs. The paper used
> samples from patients with multiple organ failure in ICU but it may be
> possible in your patient also. I am not sure if anyone in the UK offers
> whole blood glutathione (we do it here but Aus is a long way away!), if
> there is be careful of the collection procedure (EDTA blood immediately
> deproteinised in SSA) as glutathione degrades quite rapidly due to the
> action of gamma GT.
>
> Hope this helps.
>
> Peter Vervaart BAppSci FAACB
> Senior Scientist, Department of Clinical Biochemistry
> Honorary Research Fellow, MCRI
> Women's and Children's Health
> Flemington Road
> Parkville Victoria 3052
> Australia
> Phone: 613 9345 5906
> Fax: 613 9349 1819
> Mobile: 0409 233 738
> Web: www.rch.unimelb.edu.au/biochem/gastro
> ----- Original Message -----
> From: "Tim Hull" <[log in to unmask]>
> To: "[log in to unmask] Ac. Uk" <[log in to unmask]>
> Cc: "George Noy" <[log in to unmask]>
> Sent: Tuesday, November 14, 2000 1:43 AM
> Subject: Help with results
>
>
> >
> > Dear all,
> >
> > We obtained the following set of puzzling results on a patient today. Can
> > anyone offer an explanation. The patient is a 33 year old female in our
> > cardiac centre. She is on the following drug therapy: Digoxin, Lasix,
> > Aldactone and FeFol she is pregnant and has heart failure.
> >
> > ALP 353 U/L (upto 240)
> > ALT 9 U/L (2 to 39)
> > AST 24 U/L (2 to 32)
> > T CK < 0 U/L (50 to 190) (Actual reading -21)
> > LDH 1575 U/L (230 to 460)
> >
> > At first we thought that there may be something breaking down the NADH
> which
> > fitted with the high LDH and Negative CK values, however the AST and ALT
> are
> > also NADH-NAD reactions so you would expect them to be high also. The
> > reaction monitor on our Hitachi 917 showed no OD increase occuring after
> the
> > addition of the substrate (R2) for T CK. We know the negative value was
> due
> > to the OD readings after R2 was added being less than the blank.
> >
> > Are we missing something simple??
> >
> > Best Regards
> >
> > Tim
> >
> > ______________________
> >
> > Tim Hull,
> > Clinical Chemistry,
> > Armed Forces Hospital,
> > Riyadh.
> >
> >
>
>
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