Michael,
I've just looked up cardiac marker results from about the first 5 months of this year (before we changed from TnT to Ortho ECi TnI ES). We had 7 patients with CKs between 60,000 and 160,000 U/L, either due to rhabdo or trauma. The other 5 are listed.
Pt Peak CK Peak TnT Comments
1 76030 <0.01 One sample; same time
2 73687 0.59 Peaks at same time; 3 samples
3. 114185 <0.01 Three TnTs
4. 88147 0.26 TnT 0.01 at peak CK and 0.02 five hours later; rise and fall of TnT several days later
5. 70024 0.21 Both peaks at same time and declining.
I think skeletal muscle TnT does not crossreact with cTnT assay (based on pts 1 and 3). I think your patient and my 2, 4 and 5 had some cardiac injury; could be trauma or toxic effects; renal insufficiency may play a role.
We recently attended a wel grown 15 year old girl who presented with a Glascow Coma Scale score of 3 after an evening of bourbon and ecstasy (MDMA or Methylenedioxymethamphetamine) ingestion. The ecstasy was stronger than usual.
She developed rhabdomyolysis with CKs of 100,000 U/L. She also developed some renal embarassment with creatinine to 190 umol/L and some hepatic injury as well.
She is good now. Laughing and joking.
My question has to do with a Troponin T (NR: <0.03) of 0.15 ug/L obtained at about 60 hours while the CK was still 60,000 U/L. No myoglobin measured.
She has had no evidence of cardiac injury by rhythm, ECG, symptoms, or physical signs. No cardiac ultrasound undertaken.
I expect that all of this TnT is skeletal TnT not cardiac TnT. What do you reckon?
Thanks.
Michael P Metz
BS, MD, FAAP, MAACB, FRCPA
Chemical Pathologist
Division of Laboratory Medicine
Women's & Children's Hospital
72 King William Road
North Adelaide, South Australia
5006
phone: 08 8161 7483
mobile: 0421 098 430
e-mail: [log in to unmask]
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