High Creatine Kinase Activity Research Articles

Lifetime prevalence and correlates of syncope in five ancestry groups. The HELIUS study.

To explore the lifetime prevalence and correlates of syncope in the general population. Through stratified random sampling, we included 14,937 White-European, Asian, Turkish, Moroccan, and West-African ancestry adults (18-70 y) in the cross-sectional Healthy Life in an Urban Setting (HELIUS) population study. We assessed syncope history by ancestry, and the potential correlates body mass index (BMI), systolic/diastolic blood pressure (SBP/DBP), resting plasma activity of creatine kinase (CK), the ATP-generating enzyme that facilitates cardiovascular contractility and sodium retention, and in a subgroup, supine cardiac contractility (dP/dt), cardiac output (CO) and systemic vascular resistance (SVR). Mean age of the participants (39% men) was 43.3 y (SD12.9). Lifetime prevalence of syncope in women/men was respectively (%), White-European 42/24; Asian 34/19; Moroccan 32/16; Turkish 30/17; and West-African 20/14. Mean age at first syncope was 24 y (SD13). Participants with syncope history had lower SBP, DBP, BMI, CK, and modestly lower dP/dt and CO, but not SVR. In multivariable regression analysis, male sex (OR 0.52 [0.48 to 0.57]), West-African ancestry (0.59 [0.54 to 0.65]), and CK (0.56 [0.46 to 0.69]/log CK increase) were negatively associated with syncope. This study indicates that West-African ancestry, male sex, and high activity of the pressor enzyme CK are associated with lower syncope prevalence. These findings may inform further studies on the hemodynamics of syncope.

MiR-129 Attenuates Myocardial Ischemia Reperfusion Injury by Regulating the Expression of PTEN in Rats.

PTEN/AKT signaling plays pivotal role in myocardial ischemia reperfusion injury (MIRI), and miRNAs are involved in the regulation of AKT signaling. This study was designed to investigate the interaction between miR-129 and PTEN in MIRI. A MIRI rat model and a hypoxia reoxygenation (H/R) H9C2 cell model were constructed to simulate myocardial infarction clinically. TTC staining, creatine kinase (CK) activity, TUNEL/Hoechst double staining, Hoechst staining and flow cytometer were used for evaluating myocardial infarction or cell apoptosis. miR-129 mimic transfection experiment and luciferase reporter gene assay were conducted for investigating the function of miR-129 and the interaction between miR-129 and PTEN, respectively. Real-time PCR and western blotting were performed to analyze the gene expression. Compared to the control, MIRI rats presented obvious myocardial infarction, higher CK activity, increased expression of caspase-3 and PTEN, decreased expression of miR-129, and insufficient AKT phosphorylation. Consistently, H/R significantly increased the apoptosis of H9C2 cells, concomitant with the downregulation of miR-129, upregulation of PTEN and caspase-3, and insufficient phosphorylation of AKT, while miR-129 mimic obviously inhibited the expression of PTEN and caspase-3, increased the AKT phosphorylation, and decreased the cell apoptosis. Additionally, miR-129 mimic obviously decreased the relative luciferase activity in H9C2 cells. To our best knowledge, this study firstly found that the low expression of miR-129 accelerates the myocardial cell apoptosis by directly targeting 3′UTR of PTEN. miR-129 is an important biomarker for MIRI, as well as a potential therapy target.

Circulating microRNAs after a 24-h ultramarathon run in relation to muscle damage markers in elite athletes.

Ultra-endurance sports are growing in popularity but can be associated with adverse health effects, such as exercise-induced muscle damage (EIMD), which can lead to exertional rhabdomyolysis. Circulating microRNAs (miRNAs) may be useful to approach the degree of EIMD. We aimed to (1) investigate the relevance of circulating miRNAs as biomarkers of muscle damage and (2) examine the acute response of skeletal/cardiac muscle and kidney biomarkers to a 24-h run in elite athletes. Eleven elite athletes participated in the 24-h run World Championships. Counter-movement jump (CMJ), creatine kinase (CK), myoglobin (Mb), creatinine (Cr), high-sensitive cardiac troponin T (hs-cTnT), and muscle-specific miRNA (myomiR) levels were measured before, immediately after, and 24 and 48h after the race. CMJ height was reduced immediately after the race (-84.0±25.2%, p<0.001) and remained low at 24h (-43.6±20.4%, p=0.002). We observed high CK activity (53239±63608 U/L, p<0.001) immediately after the race, and it remained elevated 24h after (p<0.01). Circulating myomiR levels (miR-1-3p, miR-133a-3p, miR-133b, miR-208a-3p, miR-208b-3p, and miR-499a-5p) were elevated immediately after the 24-h run (fold changes: 18-124,723, p<0.001) and significantly (p<0.05) correlated or tended to significantly (p<0.07) correlate with the reduction in CMJ height at 24h. We found no significant correlation between CMJ height loss at 24h and CK (p=0.23) or Mb (p=0.41) values. All elite ultramarathon runners included in our study were diagnosed with exertional rhabdomyolysis after the 24-h ultramarathon race. MyomiR levels may be useful to approach the degree of muscle damage.

Semen Creatine and Creatine Kinase Activity as an Indicator of Sperm Quality.

The role of creatine (Cr) and creatine kinase (CK) in sperm function remains unclear. The study aimed to assess Cr and CK in seminal plasma and test their association with sperm characteristics. The study included 62 males with couple's infertility and 26 males who have already fathered children. Semen Cr and CK were assessed by GC-MS and spectrophotometry, respectively. Seminogram parameters were analyzed using conventional methods. Cytomorphologic analysis of sperm showed normozoospermia in 53 men (NS) and an asthenozoospermia (AS) in 35 men. Semen Cr was high with no significant difference between the two groups (791 ± 342 and 744 ± 422 µmol/L, respectively). However, semen CK activity was higher in AS group (1,360 ± 1,050 vs. 830 ± 580 U/L, p = 0.013). Semen Cr was positively related to progressive motility (r = 0.284; p = 0.010). Semen CK was negatively correlated with sperm concentration (r = -0.29; p = 0.01), progressive motility (r = -0.26; p = 0.03), and the percentage of abnormal spermatozoa (r = -0.28; p = 0.02). Semen contains high amounts of Cr and increased CK activity. Low semen Cr is associated with reduced sperm motility while high CK activity is associated with poor sperm quality. The findings suggest that Cr is of importance for sperm metabolism and that Cr supplementation could be useful in males with poor quality sperm.

Creatine kinase and blood pressure in women with a history of early-onset preeclampsia.

High plasma creatine kinase (CK) activity is associated with hypertension in the general and pregnant population. We hypothesize that women with a history of early-onset preeclampsia are prone to hypertension due to a high CK activity level. Nine to 16 years after pregnancy, serum CK activity and blood pressure were measured in 117 women with a history of early-onset preeclampsia and 50 women with a history of an uncomplicated pregnancy. CK activity levels of the two groups were compared using the Mann-Whitney U test. The association between CK activity and blood pressure was evaluated by means of multivariable regression analysis. There was no significant difference in median (interquartile range) CK activity between women with a history of early-onset preeclampsia and an uncomplicated pregnancy (59.00 [47.00-85.00] vs. 58.00 [46.50-75.25], respectively, p = 0.774). The association between CK and systolic blood pressure was significant in women with a pregnancy history of early-onset preeclampsia (regression coefficient [95% confidence interval]: 0.123 mmHg [0.020-0.226], p = 0.019), and a trend was found for diastolic blood pressure (p = 0.069). CK and blood pressure were not significantly associated in women with a history of an uncomplicated pregnancy. Median CK did not significantly differ between the two groups. Serum CK activity was significantly associated with systolic blood pressure in women with a history of early-onset preeclampsia. These data suggest that CK is not a predominant factor in the increased risk of hypertension in women with a history of early-onset preeclampsia.

300. Creatine kinase: An independent risk factor for high blood pressure during pregnancy

Hypertensive disorders in pregnancy not only pose a major burden during pregnancy, but are also associated with an increased risk for hypertension later in life. Plasma creatine kinase (CK) activity is identified in the general population as an independent risk factor for hypertension. We hypothesize that plasma CK activity is similarly associated with blood pressure during pregnancy. Women who participated in the Amsterdam Born Children and their Development-study were eligible for the current study. The associations between plasma CK activity and blood pressure measurements during pregnancy, and between plasma CK activity and hypertensive disorders in pregnancy (gestational hypertension, HELLP, preeclampsia and eclampsia) were evaluated using multiple linear- and logistic regression models, respectively. In 3.619 pregnant women, plasma CK activity was significantly associated with all blood pressure outcomes. This was most pronounced for the mean systolic blood pressure with a regression coefficient of 3.48 mmHg (CI 1.67 to 5.28, p Our data show that high plasma CK activity measured in early pregnancy is an independent risk factor for high blood pressure during pregnancy and is associated with severe gestational hypertension diagnosed before 34 weeks of gestation, while no significant association was found between CK and other hypertensive disorders in pregnancy.

Takotsubo syndrome and chronic kidney disease: a deadly duet in long-term follow-up.

Introduction The prognosis of takotsubo syndrome (TTS) was recognized as benign. However, patients with TTS and chronic kidney disease (CKD) more often experience severe complications in the acute phase of the disease, particularly sudden cardiac arrest. Objectives We aimed to assess the impact of CKD on early and long-term outcomes, including mortality, among 95 patients with TTS. Patients and methods All patients underwent coronary angiography. Clinical, biochemical, and other medical data were recorded. Estimated glomerular filtration rate was assessed using the CKD‑EPI formula. Results CKD was diagnosed in 32% of the patients. Contrast‑induced acute kidney injury (CI‑AKI) was not reported in any of the patients. Patients with CKD were older but had a lower prevalence of positive cardiovascular family history as well as higher creatine kinase activity and concentrations of inflammatory parameters. During hospitalization, sudden cardiac arrest was more common in CKD patients. In‑hospital, 1‑year, and long‑term mortality rates were the highest in CKD patients, reaching 33.3% in long‑term follow‑up. Predictors of death in a multivariate analysis were body mass index, ejection fraction, and serum creatinine concentrations. Conclusions CKD is a novel and still underestimated risk factor for TTS. It may trigger TTS but, more importantly, it adversely affects the outcomes. Thus, it is important to assess kidney function in all patients with TTS to evaluate the risk of morbidity and mortality in follow‑up, as well as to adjust drug doses and implement preventive measures to avoid CI‑AKI when coronary angiography or contrast‑enhanced computed tomography is performed.

Redefining the Gold Standard of Myocardial Infarction Using Troponin T

Featured Article: Ohman EM, Armstrong PW, Christenson RH, Granger CB, Katus HA, Hamm CW, et al. Cardiac troponin T levels for risk stratification in acute myocardial ischemia. N Engl J Med 1996;335,1333–41.2 Sir William Osler taught us that observations from patients could inform us. In my case, an event during my internship in 1981 led me to question how accurate the diagnosis of myocardial infarction (MI)3 was. A 28-year-old man was admitted after he collapsed at the end of the Dublin marathon race. His electrocardiogram (ECG) was very abnormal. Myocardial biomarkers were increased, with high total creatine kinase (CK) and CK-MB activities. Later coronary angiograms demonstrated normal coronary arteries. I followed this up by a formal study showing that the prior “gold standard” markers of MI, CK, and CK-MB were frequently increased in marathon runners, while infarct-avid scanning failed to detect any MI (1). At the time, troponin testing was in its infancy and a standardized test was not available. This interest in biomarkers continued after I came to Duke University in 1987, but focused more on the kinetics and the relationship to the ECG. Collaboratively with Galen Wagner and Rob Christensen, we performed several studies on a small cohort of patients with established MI who received fibrinolytic therapy to establish reperfusion (2). I enjoyed digesting the data together and exploring it in several …

Cardiovascular function is not associated with creatine kinase activity in a black African population: The SABPA study

BackgroundHigher creatine kinase (CK) activity is associated with the development of cardiovascular disease in black African populations. We compared CK activity and investigated associations of blood pressure with CK activity in black and white men as well as black and white women.MethodsAmbulatory blood pressure, total peripheral resistance and pulse wave velocity of 197 black and 208 white participants were determined and serum CK activity was measured.ResultsBlood pressure and pulse wave velocity were higher in black men and women (all p < 0.001) when compared to their white counterparts. CK activity only varied between black and white women (75.9 U/l vs 62.8 U/l, p = 0.009), even after adjusting for age, body mass index and physical activity. Despite the worse cardiovascular profile of black men and women, and the higher CK activity in the black women, we were unable to link blood pressure, pulse wave velocity or total peripheral resistance with CK activity, in the black African population. In white men, total peripheral resistance was associated with CK activity (R2 = 0.32; β = 0.25; p = 0.009), whereas systolic blood pressure (R2 = 0.46; β = 0.17; p = 0.03) and pulse pressure (R2 = 0.31; β = 0.21; p = 0.01) were associated with CK activity in white women.ConclusionsThe lack of associations in the black African population suggests that the link between a worse cardiovascular profile and CK activity may be overshadowed by other contributing factors. Whereas, the established link between cardiovascular function and CK activity in the white groups may be the result of enhanced smooth muscle cell contractility and/or attenuated nitric oxide synthesis capacity.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0315-2) contains supplementary material, which is available to authorized users.

Exercise‐induced muscle damage in healthy men with low choline intake

Both very low choline intake and intense exercise in healthy men can trigger peak muscle soreness a few days later and a rise of creatine kinase (CK) activity in peripheral blood indicating muscle damage.We wanted to know whether men susceptible to exercise‐induced muscle damage have lower dietary choline intake than men with more robust muscles and whether their heightened muscle fragility is associated with low lean body mass.We investigated in 58 healthy Caucasian men the increase of CK activity three days after 12 eccentric elbow flexors (Biodex 4, Biodex Medical Systems Inc., Shirley, NY) with the non‐dominant arm. This single bout of exercise took little more than one minute to complete. The dynamometer tracked the patient's torque and provided instant feedback throughout the exercises. The same measurements and exercises were done on the non‐dominant arm at the initial visit and three days later. Participants indicated on an analog scale after each exercise test the level of discomfort or pain they had experienced. A whole body dual energy x‐ray absorptiometry scan (Lunar iDXA, GE Healthcare) was used for the assessment of body composition and to estimate total and regional lean body masses. A trained dietitian supervised the automated 24‐hour diet recall assessments on days 1 and 4 for each subject with the ASA24 online system, demonstrated food models for improved accuracy of portion sizes, confirmed reported food items and probed for missing food items prior to submission, and asked additional quality control questions to promote comprehensive reporting. The recall on day 2 was reviewed and discussed with the participant over the phone.The study was registered at Clinicaltrials.gov (NCT01722448).The median change of CK activity three days after the initial bout of exercise was +49 U/L (+36%). We classified a significant minority (9 of 58) of the investigated men as high responders (HR) because they had exceptionally high CK activity after the exercise (between 4 and 27 times of the upper reference limit). At the other end of the spectrum were men (19 of 58) with no increase of CK activity (non‐responders, NR); their median change of CK activity was −22 U/L (−20%).The single bout of eccentric arm flexor exercise greatly reduced arm strength in HR when assessed three days later, but changed strength very little in NR. Average power in HR was 32% lower than initially (p&lt;0.0005), while NR had an average decrease of 7%. The difference in response between the two groups was statistically highly significant (p&lt;0.00001). Lean body mass was 10% lower in HR than in NR (17.1 vs. 19.1 kg/m2, p&lt;0.04).More HR reported low choline intake (less than an average of 330 mg/day or 60% of adequate intake, AI) than NR (7 of 9 vs. 6 of 19, p&lt;0.05). Men with higher choline intake also tended to have less muscle soreness (r = −0.261, p&lt;0.05), better muscle performance after exercise (r = 0.310, p&lt;0.02), and higher lean body mass (r = 0.383, p&lt;0.005).These findings support our initial hypothesis that men susceptible to exercise‐induced muscle damage are more likely to have low choline intake than men with more resilient muscles. Increased vulnerability to intense exercise may discourage HR men to engage in physical activities and limit their ability to build up and maintain high muscle mass.Support or Funding InformationSupported by a grant from the UNC Nutrition Research Institute

Evaluation of creatine kinase activity and inorganic phosphate concentration in adult nigerian homozygous and heterozygous hemoglobin phenotypes.

Background:Biochemical parameters vary in subjects with different hemoglobin phenotypes, compared with normal controls.Aim:The aim was to evaluate serum creatine kinase (CK) activity and inorganic phosphate concentrations in Nigerian adults with homozygous and heterozygous hemoglobin phenotypes.Subjects and Methods:A prospective study, carried out at the hematology out-patient clinic of our hospital, a community health center and a private hospital, all in Anambra state. Subjects included hemoglobin phenotypes AA, AS, and SS, in steady state and vaso-occlusive crisis (VOC). Samples were collected for serum CK activity and inorganic phosphate concentrations. Data obtained were analyzed using SPSS 16.0 (SPSS Inc., Chicago IL, USA). Means were compared using the Student's t-test and statistical significance was set at P < 0.05.Results:A total of 100 subjects participated in the study. There was a statistically significant difference in the means of serum CK activity in hemoglobin SS (HbSS) in VOC versus hemoglobin AA (HbAA) (P = 0.01) and HbSS in steady state versus HbAA (P = 0.02) but not in hemoglobin AS (HbAS) versus HbAA (P = 0.79) and HbSS in VOC versus HbSS in steady state (P = 0.06). A statistically significant difference was noted in the means of serum inorganic phosphate concentration in HbSS in VOC versus HbAA (P = 0.01), but not in HbSS in steady state versus HbAA (P = 0.43), HbSS in VOC versus HbSS in steady state (P = 0.09) and HbAS versus HbAA (P = 0.20).Conclusion:Sickle cell disease is a predictor for high serum CK activity and low serum concentration of inorganic phosphate, particularly in VOC. There may be a need to monitor serum CK activity in HbSS subjects presenting with major VOC.

Creatine Treatment to Relieve Muscle Pain Caused by Thyroxine Replacement Therapy

To the Editor: The impact of thyroid deficiency and its reversal by T4 replacement therapy on glucose metabolism remained controversial [1–4]. Small doses of thyroxine (1 µg/kg) normalized most of the intermediary metabolic parameters of thyroidectomized rats [5], while 20-times-higher doses would be needed to depress the high rates of thyroid-stimulating hormone (TSH) release of pituitary via feedback inhibition [6]. Thyroxine levels can be brought up to normal with oral thyroxine pills from 25 to 200 µg/day. Under constant balanced conditions, low levels of thyroid hormones maintain normal intermediary metabolism; insufficient thyroxine administration results in hypothyroidism; and high thyroxine doses cause swinging to hyperthyreoidic symptoms. The regulatory functions of adenohypophysis and pituitary-dependent glands are to smooth out oscillations. In thyroidectomized patients, the negative feedback loop does not function, and the development of hypothyreoidic symptoms are prevented by thyroxine replacement therapy. This letter presents a hypothyroid case where the muscular side effects following thyroxine replacement therapy manifested as muscle pain. Long-term protection against thyroxine replacement therapy-induced muscle pain has been provided by low doses (2 g/day) of creatine monohydrate administration. In 1993, our male patient was 49 years old when his hyperthyreosis was diagnosed. In 2001, the patient had 7–8 kg loss in weight in 6 months and hyperthyreosis recidiva was diagnosed. A single dose of p.o. administered radioisotope 131I (240 MBq) was applied in a capsular form. Three months later (December 2001), laboratory parameters showed high creatine kinase (894 U/L) and transaminase (GOT 65 IU/L, GPT 61 IU/L) activities. Elevated creatine kinase levels may reflect injury in myocardial infarction, muscle breakdown, muscular dystrophy, myositis, reduced adenosine triphosphate (ATP) level in muscle, and acute renal failure. Upon the radioactive destruction of thyroid function, the patient experienced excessive muscle pain and involuntary defecation of stool for several days. …

Clenbuterol toxicosis in three Quarter Horse racehorses after administration of a compounded product

3 Quarter Horse racehorses were examined for suspected clenbuterol overdose 12 to 24 hours after administration by mouth of a compounded clenbuterol product. All horses developed sinus tachycardia, muscle tremors, hyperhidrosis, and colic. Abnormalities on serum biochemical analysis included hyperglycemia, azotemia, and high creatine kinase activity. The presence of clenbuterol in the serum of all 3 horses and in the product administered was confirmed and quantified by use of liquid chromatography-electrospray tandem mass spectrometry. Propranolol (0.01 mg/kg [0.005 mg/lb], IV) was administered to all 3 horses for antagonism of β-adrenergic effects and caused a transient decrease in heart rate in all patients. All horses also received crystalloid fluids IV and other supportive treatment measures. Two horses were euthanatized (2 and 4 days after admission) because of complications. One horse recovered and was discharged 4 days after admission to the hospital. In the 2 nonsurviving horses, skeletal and cardiac muscle necrosis was evident at necropsy, and tissue clenbuterol concentrations were highest in the liver. Clenbuterol is a β(2)-adrenergic receptor agonist licensed for veterinary use as a bronchodilator. At doses ≥ 10² μg/kg (4.5 μg/lb), in excess of those normally prescribed, β-adrenergic stimulation by clenbuterol may cause sustained tachycardia, muscle tremors, hyperglycemia, and cardiac and skeletal muscle necrosis. Laminitis, acute renal failure, rhabdomyolysis, and cardiomyopathy were fatal complications associated with clenbuterol overdose in 2 horses in the present report. At the dose administered, propranolol was effective for short-term control of sinus tachycardia, but it did not alleviate all clinical signs in patients in the present report. These cases demonstrated the risks associated with the use of nonprescribed compounded medications for which the ingredients may be unknown.

Creatine kinase activity and blood pressure in a normal population: the Tromsø study

In the vast majority of cases the cause for hypertension is not known. On the basis of observations from black and multiethnic populations, it has been hypothesized that a genetically high tissue creatine kinase activity may be an independent factor responsible for primary hypertension. If the relation between creatine kinase and blood pressure is causal, it is reasonable to believe that it will be independent of ethnicity and present in different populations. In this cross-sectional study, we examined whether creatine kinase was associated with blood pressure in a large Caucasian normal population. Data on creatine kinase and blood pressure were analyzed in a random sample of 12 776 men and women (65% of those eligible), aged 30-87 years from a normal population in the municipality of Tromsø, Norway. We used linear regression to model the association between creatine kinase and blood pressure. Creatine kinase was independently associated with blood pressure. A one unit increase in log CK was associated with a 3.3 (95% CI 1.4-5.2) mmHg increase in systolic blood pressure and a 1.3 (95% CI 0.3-2.3) mmHg increase in diastolic blood pressure, after adjustment for age, sex, body mass index, s-glucose, s-creatinine, physical activity and alcohol consumption. The creatine kinase effect on blood pressure was independent of antihypertensive medication, and no difference in creatine kinase level was found between those with controlled and uncontrolled hypertension (geometric mean 101 vs. 104 IU/l, P = 0.1). Creatine kinase was associated with blood pressure in this population.

Severe polymyositis and neuritis in a cat

A 4-year-old domestic shorthair cat was evaluated for a 1-week history of shifting limb lameness that progressed to tetraparesis. Physical examination revealed generalized muscle atrophy and signs of discomfort when the muscles of the appendicular skeleton were palpated. Neurologic examination revealed diminished myotatic and withdrawal reflexes in all 4 limbs. Results of a CBC indicated mild neutrophilia, and serum biochemical analysis revealed mild hyperalbuminemia and high creatine kinase activity. The cat was anesthetized, and an electromyogram (EMG), CSF sample, and nerve and muscle biopsy specimens were obtained. The EMG revealed positive sharp waves and fibrillation potentials, CSF analysis revealed albuminocytologic dissociation, and histologic examination of muscle and nerve specimens revealed severe myositis and neuritis. Immune-mediated polymyositis and neuritis were suspected. With physical therapy and long-term corticosteroid drug treatment, the cat recovered complete motor nerve function. The severity and rapid progression of clinical signs, combined with the EMG abnormalities and histologic findings, could have led to inappropriate euthanasia for this cat. Veterinarians should be aware that immune-mediated polymyositis and neuritis in cats can have an excellent prognosis with appropriate, long-term treatment.

Anesthesia Case of the Month

History A 2-year-old 900-g (2.0-lb) female blue and gold macaw (Ara ararauna) was referred to the Louisiana State University School of Veterinary Medicine with a history of respiratory distress and coughing. No other abnormalities were observed on external physical examination. Results of serum biochemical analysis revealed high creatine kinase (CK) and aspartate aminotransferase (AST) activities, and CBC results revealed a high number of heterophils. Radiography was diagnostically unrewarding. Initiation of treatment for fungal and bacterial infections and oxygen supplementation failed to alleviate the bird’s clinical signs of disease. Partial obstruction of the trachea was a differential diagnosis for the bird’s respiratory problems. Therefore, tracheoscopy was required as part of the diagnostic workup. This precluded tracheal intubation as a means for maintaining general anesthesia.

Hematology and serum clinical chemistry reference intervals for free‐ranging Scandinavian gray wolves (Canis lupus)

Scandinavian free-ranging wolves (Canis lupus) are endangered, such that laboratory data to assess their health status is increasingly important. Although wolves have been studied for decades, most biological information comes from captive animals. The objective of the present study was to establish reference intervals for 30 clinical chemical and 8 hematologic analytes in Scandinavian free-ranging wolves. All wolves were tracked and chemically immobilized from a helicopter before examination and blood sampling in the winter of 7 consecutive years (1998-2004). Seventy-nine blood samples were collected from 57 gray wolves, including 24 juveniles (24 samples), 17 adult females (25 samples), and 16 adult males (30 samples). Whole blood and serum samples were stored at refrigeration temperature for 1-3 days before hematologic analyses and for 1-5 days before serum biochemical analyses. Reference intervals were calculated as 95% confidence intervals except for juveniles where the minimum and maximum values were used. Significant differences were observed between adult and juvenile wolves for RBC parameters, alkaline phosphatase and amylase activities, and total protein, albumin, gamma-globulins, cholesterol, creatinine, calcium, chloride, magnesium, phosphate, and sodium concentrations. Compared with published reference values for captive wolves, reference intervals for free-ranging wolves reflected exercise activity associated with capture (higher creatine kinase activity, higher glucose concentration), and differences in nutritional status (higher urea concentration).

Successful management of a dog that had severe rhabdomyolysis with myocardial and respiratory failure

CASE DESCRIPTION - A 6-year-old castrated male Llewelyn Setter was evaluated because of an acute onset of myalgia and respiratory distress. CLINICAL FINDINGS - Physical examination revealed a stiff stilted gait, swollen muscles that appeared to cause signs of pain, panting, and ptyalism. The dog had a decrease in palpebral reflexes bilaterally and a decrease in myotatic reflexes in all 4 limbs. The panniculus reflex was considered normal, and all other cranial nerve reflexes were intact. Serum biochemical analysis revealed markedly high cardiac troponin-I concentration and creatine kinase and aspartate aminotransferase activities. Urinalysis revealed myoglobinuria. Results for thoracic and abdominal radiography, blood pressure measurement, and an ECG were within anticipated limits. Echocardiographic findings were consistent with secondary systolic myocardial failure. Arterial blood gas analysis confirmed hypoxemia and hypoventilation. The dog had negative results when tested for infectious diseases. Examination of skeletal muscle biopsy specimens identified necrotizing myopathy. TREATMENT AND OUTCOME - Treatment included ventilatory support; IV administration of an electrolyte solution supplemented with potassium chloride; administration of dantrolene; vasopressor administration; parenteral administration of nutrients; use of multimodal analgesics; administration of clindamycin, furosemide, mannitol, and enrofloxacin; and dietary supplementation with L-carnitine and coenzyme Q(10). Other medical interventions were not required, and the dog made a rapid and complete recovery. CLINICAL RELEVANCE - Necrotizing myopathy resulting in rhabdomyolysis and myoglobinuria can lead to life-threatening physical and biochemical abnormalities. Making a correct diagnosis is essential, and patients require intensive supportive care. The prognosis can be excellent for recovery, provided there is no secondary organ dysfunction.

Predictive factors for generalized seizures after deliberate citalopram overdose

Seizures are a recognized complication of citalopram overdose. The present study sought to establish risk factors for seizures in this high-risk patient group, including stated dose ingested, co-ingested drugs or ethanol, and electrolyte disturbances. A retrospective casenote review was carried out of patients who attended the Emergency Department due to citalopram overdose between January 2000 and July 2007 inclusive. Stepwise logistic regression analysis considered age, gender, stated citalopram dose, acute ethanol consumption, co-ingested drugs, administration of activated charcoal, and hyponatraemia. There were 241 patients (177 women), and the median (interquartile range) stated citalopram dose was 300 mg (200 to 600 mg). Generalized seizures occurred in 18 patients (7.5%). Logistic regression analysis found co-ingested tricyclic antidepressants or venlafaxine predicted seizures with odds ratio = 15 (95% confidence interval 3, 75). In the absence of co-ingested drugs, the minimum citalopram dose associated with seizures was 400 mg. Odds ratio for seizures = 1.1 (95% confidence interval 1.0, 1.2) for every 100 mg increment in citalopram dose. Seizures were associated with a greater need for invasive ventilatory support, higher creatine kinase activity, and prolonged hospital stay. Generalized seizures are an important manifestation of citalopram toxicity, and cannot be explained solely by electrolyte disturbances or co-ingestion of other drugs or ethanol. The strongest predictors of seizures in this patient series were ingestion of high citalopram dosages and co-ingestion of drugs capable of lowering seizure threshold.

Adverse effects of long term, continual administration of high doses of albendazole in the treatment of echinococcal disease

Modern treatment of cystic echinococcosis, except for surgical treatment and percutaneous drainage of cyst considers also administration of albendazole as a type of individual therapy. However, clinicians fear of the serious adverse effects of high doses of albendazole, first of all the elevation of serum transaminases activity, very frequently results in subdosing of albendazole and wrong conclusions its efficacy and safety. The aim of this study was to investigate adverse effects of a longterm, continual administration of high doses of albendazole in the treatment of patients with echinococcal disease. A total of 42 patients (mean age 40.4 +/- 18.3 years) with echinococcal disease were included in the study. They were treated with continual administration of high doses of albendazole within the period of 4 to 6 months. The subgroups of 27 and 15 patients were treated with 15-20 mg/kg/day and with 21-25 mg/kg/day albendazole, respectively. The patients in the control group (18 with surgical treatment, 6 with percutaneous drainage of cyst) were treated with 800 mg albendazole per day (< 15 mg/kg body weight) in the cycles of 28 days (1-3 cycles) and a two-week pause between them. In the study group adverse effects of albendazole were registered in 20 (47.6%), whereas in the control group in 6 (30.0%) of the patients. In both subgroups elevated activity of serum transaminases were found more frequently in the study group compared to the control one (35.7% vs 25%, p < 0.05), especially in the patients who were treated with higher doses of albendazole. The patients in the study group, compared to the patients in the control group had significantly higher mean activity of serum alanin aminotransferase in the course of the second and third month of the therapy (p < 0.05). Administration of albendazole due to adverse effects was stopped in 3 (7.1%) of the patients in the study group. Two (4.8%) of them had a very high activity of serum transaminases and one had a muscle pains and high activity of serum creatine kinase. After the interruption of the therapy we documented a nonnalization of serum enzyme levels in all the patients. Longterm, continual administration of high doses of albendazole in the patients with echinococcal disease results in significant elevation of serum transaminases activity, compared to the patients treated with albendazole in the cycles, but in the majority of the patients serum transaminases activity was normalizated by the end of a 6-month period.