Case 4: A 2½-year-old boy was admitted because of weakness and a clinical suspic
ID: 51357 • Letter: C
Question
Case 4: A 2½-year-old boy was admitted because of weakness and a clinical suspicion of a muscular disorder.
Lab Data:
Day 1
Reference
Total CK
6,540
50 U/L
% CK-2
9.5
0%
Total LD
0
200 U/L
% LD-1
27
25%
% LD-2
39
35%
% LD-3
24
20%
% LD-4
2
10%
% LD-5
8
10%
AST
116
50 U/L
ALT
1
50 U/L
1.Why is CK-2 not increased?
2.Why are the LD isoenzymes 1, 2, and 3 increased?
3.What other analyte would also be increased in this boy’s serum?
4.What is you diagnosis for this boy?
5.What additional studies would you do on this patient?
Please answer 1-5 my book is on its way Thanks so much
Day 1
Reference
Total CK
6,540
50 U/L
% CK-2
9.5
0%
Total LD
0
200 U/L
% LD-1
27
25%
% LD-2
39
35%
% LD-3
24
20%
% LD-4
2
10%
% LD-5
8
10%
AST
116
50 U/L
ALT
1
50 U/L
Explanation / Answer
1. The value of serum creatine kinase(CK) changes with clinical progression and age in patients.Increase on CK2 levels is an indication of muscle damage.Serum creatine kinase (CK),. is a sensitive indicator of skeletal and cardiac muscle injury.As we can see from the above table CK2 is higher than the reference level in case of the patient,so the boy must be suffering from some muscular tissue damage.But the increase in CK is not so high as in case of myocardial infarction.So the patient may not have any cardiac problem but only suffering from muscular disorder,
2. LD activity is present in all cells of the body with highest concentrations in heart, liver, muscle, kidney, lung, and erythrocytes. As with other proteins used as tissue-function markers, the appearance of LD in the serum occurs only after prolonged hypoxia and is elevated in a number of clinical conditions including cardiorespiratory diseases, malignancy, hemolysis, and disorders of the liver, kidneys, lung, and muscle.
LDH-1:found in heart and red blood cells
LDH-2: found in white blood cells
LDH-3: found in lungs
LDH-4: found in kidneys, placenta, and pancreas.
An increase in LDH 1,2 and 3 is an indication of hemolysis and tissue damage in muscle.
3. Another analyte which would also be increased in the boy's serum is Pyruvate kinase enzyme(PK).PK is found in heart,skeletal muscle,liver,RBCs,lung,pancreas,brain.Muscular disorder of certain types may be asssociated with elevated levels of PK along with other serum enzymes.
4. The diagnosis for this boy would be that he is probably suffering from Duchenne muscular dystrophy (DMD). DMD usually occurs prior to 3 years old and is a muscular disorder.
5.The patient's AST levels should be checked regularly as it is also an indication of muscular tissue damage and PK and CK levels should also be checked with the progression of the disease.Carbonic anhydrase(CA) levels should also be checked because elevated CA levels are often associate with Duchenne muscular dystrophy (DMD).
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