Laboratory parameters of the patient Laboratory parameters Values Hemoglobin (g/dL) 7.6 Hematocrit (%) 23.6 MCV (fL) 64.2 RDW (%) 15.1 Platelet (103/[micro]L) 338 AST (U/L) 28 ALT (U/L) 20 BUN (mg/dL) 12.7 Kreatinin (mg/dL) 0.39 Troponin - I (ng/mL) 0.8 CK-MB (ng/mL) 10.3 MCV: Mean corpuscular volume, RDW: Red cell distribution width, BUN: Blood urea nitrogen, CK-MB: Creatinine kinase MB fraction
, AST: Aspartate aminotransferase, ALT: Alanine aminotransferase
(4) The patient was initially seen at another hospital where the ECG was performed, and the peak CK level was 1,764 U/L (reference < 230) with an MB fraction
of 626 ng/ml (reference < 4.0).
Initial laboratory study revealed mildly elevated creatine kinase MB fraction
with 7.1 ng/mL (normal range <5 ng/mL).
Creatine kinase and the MB fraction
were also normal.
Diastolic hypotension has been observed in children who receive continuous albuterol nebulization, and case reports have suggested that myocardial injury can result from undergoing continuous albuterol nebulization as evidenced by increases in creatine kinase MB fraction
(CKMB) or EKG ST segment changes.
Serum creatinine kinase peaked at 532 U/l on day 3 (MB fraction
The level of the MB fraction
of creatine phosphokinase was 333.5 U/L and the troponin level was 17.39 ng/mL.
Therefore measuring both CK (or total CK if you wish) and the MB fraction
and calculating the percent of the two improved the laboratory's role in assessing the CP patient.
Surveillance included reviews of laboratory logs (for cases with highly elevated CK but a low MB fraction
) and emergency room logs for all patients with a diagnosis of suspected fish poisoning.
One of them also recently was found to have an elevated MB fraction
of creatine kinase, apparently having suffered a heart attack.
Despite peak values in cardiac biomarkers that indicated a moderate-sized infarct (troponin I 24.95 ng/mL, reference < 0.09; creatine kinase 1421 U/L, reference < 190; MB fraction
191.7 ng/mL, reference < 5.6), in the same 7 1/2 month period during which the ECG became completely normal the left ventricular ejection fraction by echo went from 25% to > 55%, and extensive anterolateral akinesis/dyskinesis disappeared (Figure 3).
The first lab results showed no hemolytic anemia but leuko- and lymphopenia, C3: 32 mg/dl (90-180), C4: <5.72 mg/dl (10-40), IgG: 2190 mg/dl (770-1510), antinuclear antibodies (ANA) with fine speckled nuclear pattern 1:5120 (<1:160), IgM anti-beta2-glycoprotein 1 antibodies 73.2 U/ml (0-10), IgM anticardiolipin antibodies 58.8 U/ml (0-10), positive lupus anticoagulant, serum levels of creatine phosphokinase 918 UI/L (21-232), MB fraction
25 UI/L (0-6), and troponin T 26.36 ng/dl (0-0.5).