Muscle dysfunction related to clozapine treatment is largely unrecognized. We evaluated weekly creatine kinase (CK) levels in 37 consecutive clozapine-treated outpatients with chronic psychotic disorders. Those with CK elevations underwent clinical neurologic evaluation, electromyography (EMG), and nerve conduction studies. Patients with probable myopathy had a quadriceps muscle biopsy. Twenty control patients had a single CK level determination. Twenty-nine of 37 clozapine-treated patients had CK elevations. Three patients had extreme CK elevations (> 20,000 IU/L), without myoglobinuria. Mean CK levels were significantly greater in clozapine patients (194 IU/L) than in control patients (142.3, p = 0.033). Of 18 clozapine-treated patients evaluated clinically, 6 had mild proximal weakness. EMG in 13 patients was myopathic in 5, normal in 5, and neurogenic in 3. Muscle biopsy in 5 patients showed rare regenerating myofibers and mild acute denervation (1), mild type II fiber atrophy (1), minimal acute denervation (1), and normal muscle (2). In conclusion, clozapine therapy may be associated with CK elevations and, rarely, mild myopathy.
To investigate their putative capacity for lactose digestion, primed continuous orogastric infusions of [1-13C]glucose and D-[1-13C]lactose were administered on consecutive days to five premature infants (30-31 wk gestation, 15-32 days of age), who were fed by orogastric infusions of human milk or formula. By monitoring the plateau isotopic enrichment of plasma glucose using isotopomers containing the entire derivatized glucose molecule or C-2 through C-6, we were able to distinguish label appearing in the peripheral circulation deriving from unmetabolized glucose from that arising from recycled or fermented glucose (or lactose). Isotopic enrichment of the C-1 of glucose, corrected for recycling, was then calculated during each tracer infusion, and the fraction of dietary lactose subjected to in vivo hydrolysis was estimated from these values and the respective tracer infusion rates, assuming similar absorptive and metabolic fates of labeled glucose arising from either tracer. This fraction averaged 1.02 +/- 0.16 (SD), suggesting that lactose digestion is efficient by 34-wk postconceptional age.
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