Serum factors influencing creatine phosphokinase

Valproate-Associated Isolated Serum Creatine Kinase Elevation

“…Such predisposition comes from the hypothesis that associates reduced thyroid functions and increased serum CK through decreased CK clearance, presence of CK-activating factor, increased permeability of the muscle membrane, hypothermia, and increased CK release from myocytes due to a dysfunction of cellular energy metabolism. 10–12 Furthermore, impaired cellular energy mechanism-related cellular membrane damage might be of particular importance in the etiologic understanding of VPA-associated CK elevation because previous studies have reported impaired adenosine triphosphate production, which could be related to carnitine deficiency in human subjects using valproate. 13 VPA may also lead to a depletion in superoxide dismutase, catalase, and glutathione peroxidase activity, which results in increased free oxygen radicals that have direct toxic effects on the cell membrane.…”