Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (858 page)

   Alcohol

   Emetine (ipecac)—(e.g., bulimia)

   Chemical toxicity; benzene ring compounds (e.g., xylene) depolarize the surface membrane and leach out low molecular weight enzymes, producing very high levels of total CK (100% fraction muscle [MM]) with increased LD) (3–5 × normal)

   Half of patients with extensive brain infarction. Maximum levels are reached in 3 days; the increase may not appear before 2 days; levels are usually lower than in AMI and remain increased for a longer time; levels return to normal within 14 days; high mortality is associated with levels >300 IU. Elevated serum CK in brain infarction may obscure diagnosis of concomitant AMI.

   Some persons with large muscle mass (≤2 times normal) (e.g., football players).

   
Slight increase
(occasionally) in

   Variable increase after IM injection to two to six times normal level; returns to normal 48 hours after cessation of injections; rarely affects CK-MB, LD-1 (lactate dehydrogenase-1), AST

   Muscle spasms or convulsions in children

   Healthy African Americans when compared to Caucasian/Hispanic populations

   Moderate hemolysis

Decreased In

   Decreased muscle mass (e.g., elderly, malnutrition, alcoholism)

   RA (about two thirds of patients)

   Untreated hyperthyroidism