Hi Asila,
HyperCKaemia is not the primary problem in this patient. It is certainly part of the multiorgan damage - shock syndrome that this patient had due to severe dehydration (approx. water deficit 8 - 9 litres) due to indequate oral fluid intake, leading to tissue hypoperfusion including skeletal muscle, cardiac muscle and kidneys.
Regards
Mohammad
Dr. M A Al-Jubouri, MB ChB, MSc, FRCP Edin, FRCPath
Consultant Chemical Pathologist
--- On Sun, 16/10/11, Asila Al-Musheifri <[log in to unmask]> wrote:
> From: Asila Al-Musheifri <[log in to unmask]>
> Subject: ? HyperCKaemia
> To: [log in to unmask]
> Date: Sunday, 16 October, 2011, 8:17
> Dear all,
> I appreciate your feedback on the following case:
> A 33-year-old female, mentally retarded due to encephilitis
> during childhood, presented to A&E with H/O fever since
> 2 wks that was subsided 3 days ago. She gave a H/O taken IM
> injection and ?antibiotics. H/O poor oral intake resulted in
> dizziness. At the time of presentation, there was no H/O
> muscle pain or chest pain. Her examinations revealed severe
> hypotension (85/40 mmHg) and dehydration. Other examinations
> were unremarkable.
> UE1 showed: Na: 174 mmol/L, K: 4.7 mmol/L, Cl-: 128
> mmol/L, HCO3-: 19 mmol/L, Urea: 47 mmol/L, Creatinine: 429
> umol/L.
> Bone profile: corrected Ca++: 2.13 mmol/L (2.15-2.55),
> Phosphate: 2.76 mmol/L (0.7-1.45), ALP: 35 U/L (27-112).
> Mg: 1.38 mmol/L, CRP: 28 (< 5 mg/L)
> LFT: T.Bili: 28, ALT 139 IU/L, AST 173 IU/L, TP 83 g/L,
> albumin 40 g/L
> After 3 days of admission, CK was measured because she had
> Rt-side calf muscle pain that was not severe. CK result was
> 5534 U/L, sample retrieved from previous day (2nd day of
> admission) for CK measurenemt. CK was 3600 U/L.
> The patient started to recover and no muscular symptoms at
> all apart from very mild calf pain (according to the patient
> and her sister).
> On 6th day of admission, hsTnT was measured which came high
> 0.22 ug/L, peaked at a level of 0.069 ug/L (day 12).
> CK continued to increase peaking at a level of 6000 U/L (at
> day 9), then decline rapidly. Serum and Urine myoglobin was
> measured, the results were 3000 and 1246 ug/L, respectively.
>
> She has secondary hyperparathyroidism as Vitamin D3 level
> is 35 nmol/L and her PTH is 39.6 pmol/L.
> TSH level 0.26 uIU/mL.
> Patient is going for EMG and Echo soon.
> The preliminary differential diagnosis are ? Rhabdomyolysis
> ? Myositis ? dermatomyocytis ? asymptomatic hyperCKaemia
>
> What is your thought of such gradual increase in CK in
> asymptomatic patient?
> What are your DDx?
> How high CK can reach in different diseases?
>
> Your feedback is appreciated and thank you in advance.
>
> Warm regards,
> Asila Al-Musheifri
> Al-Nahdha Hospital
> Muscat-Oman
>
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