The serum activity of creatine phosphokinase is elevated in clinical and experimental tetanus due to an increased leakage into the blood of the isoenzyme contained in skeletal muscle. This might be a simple effect of the increased muscular activity characteristic of tetanus, but a direct effect of tetanus toxin on the permeability of the muscle cell membrane cannot be excluded. Hyperbaric oxygen treatment of rabbits suffering from severe tetanus produced by the intravenous injection of toxin affected neither this increased enzymatic activity nor the clinical course of the disease. Lactate dehydrogenase activity was consistently increased in human patients and alpha-hydroxybutyrate dehydrogenase activity temporarily. In rabbits, the activities of these enzymes increased in a roughly proportional fashion, suggesting myocardial damage. Serum cholinesterase activity was decreased in patients above 45 years of age. A satisfactory explanation of this phenomenon cannot be given at present.
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