Agreed that vigorous physical exercise can lead to high CK activity (often seen in marathon runners) but the very high CK in this case I think needs investigating. This person (patient) has had clinical rhabdomyolysis with muscle swelling (with very high CK and myoglobin). His arms most probably would have been very tender.
This is unlikely to be due to physical work alone (neither should a gym work-out do this).
Carnitine palmityl transferase deficiency is a possibility among a whole list of other inherited metabolic causes (McArdle's has already mentioned).
James Hooper
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Robert Lord
Sent: 26 August 2009 10:33
To: [log in to unmask]
Subject: High CK - ?further investigation
Reviewing a set of medical notes today on a 24 yr old male
who was admitted in July with a CK of 35,825. Swelling of
both arms having spent all day laying slabs in his garden.
Apparently had similar episode in Jan following exercise
at gym. Otherwise well. Medication = inhalers for asthma.
O/E muscles in both arms swollen and tender. Other tests -
TSH = normal, CRP = normal, U+E = normal, FBC = normal,
ALT = 165, LDH = 1243. Elevated urine myoglobin = 124
ug/L. Treated with iv fluids. CK = 7203 when discharged 3
days later. No follow up has been arranged.
Do you see this kind of self induced increase in CK due to
strenuous exercise or should I be suggesting follow up
regarding investigation of a possible metabolic myopathy?
Many thanks
Rob
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