Serum creatine kinase after exercise: Drawing the line between physiological response and exertional rhabdomyolysis

Abstract

CK elevations and muscle pain are common during basic training. Widely accepted laboratory diagnostic values for ER are routinely exceeded in this military recruits, suggesting that CK levels >50 times the upper limit of normal are more specific. The findings support using CK as a marker for ER. Normal laboratory reference ranges for CK should be published by ethnicity.

The effects of acetaminophen and mannitol on crush injuries in rats: Experimental study

“…[38] The most important substance secreted from muscles during rhabdomyolysis is myoglobin; levels rise and fall much faster than creatinine kinase levels (in 1-6 hours). In addition, myoglobinuria is not always visible, or may be resolved early.…”

RYR1-related rhabdomyolysis: A common but probably underdiagnosed manifestation of skeletal muscle ryanodine receptor dysfunction

“…Although there is no universally accepted definition, RM is often defined as a clinical syndrome associated with severe muscle pain, sudden elevation and subsequent fall of serum creatine phosphokinase (CPK) levels with or without myoglobinuria. There is no consensus concerning the exact level of CPK rise required to fulfil the definition of RM, with suggested CPK levels ranging from > 5, > 10, > 20 to even > 50 times the upper limit of normal (ULN) [9]. ERM is defined as RM preceded by triggering strenuous exercise (often under environmental conditions at the extremes of the temperature scale).…”

“…reporting a large cohort of representative cases with physiological ERM offers some practical guidelines at least for the initial steps (summarized in Box 4 and [9]). The goals of both inpatient and/or outpatient treatment are to avoid renal injury, prevent further muscle injury, and to limit complications resulting from electrolyte disturbances; this is summarized in Box 5.…”

Treningsutløst rabdomyolyse – en ny tendens?

“…En absolutt grenseverdi for diagnosen rabdomyolyse finnes ikke, men en kreatininkinaseverdi over (fem til) ti ganger øvre referansegrense aksepteres av flere som en aktuell grense (1,2). Trening kan medføre en ikkepatologisk stigning i kreatininkinaseverdi, og verdier over 50 ganger øvre referansegrense er dermed foreslått som grense -for ikke å overdiagnostisere tilstanden (25). 23 pasienter (70 %) inkludert i vår studie hadde en kreatininkinasestigning over 50 ganger øvre referansegrense.…”