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December 10, 1982

Creatine Kinase Activity Following Strenuous Exertion

Author Affiliations

Huron Road Hospital Cleveland

JAMA. 1982;248(22):2971-2972. doi:10.1001/jama.1982.03330220017017

To the Editor.—  A number of reports have appeared in the medical literature that describe elevations in creatine kinase (CK) levels following physical exertion. Most of the attention in these articles has been focused on the occurrence of an MB isoenzyme, with emphasis that this isoenzyme may be of skeletal muscle origin and that its presence does not necessarily indicate a myocardial infarction (JAMA 1981;246:2049). The possibility of diffuse myocytolysis of cardiac muscle has also been considered as a basis for MB isoenzyme appearance in such cases (JAMA 1982;247:2368). A case of severe CK elevation following strenuous exertion occurred. Rather than focusing on the presence of an MB isoenzyme, which did appear in this case, we will emphasize the enormity of the total CK elevation possible under such circumstances.

Report of a Case.—  A total CK activity of 13,280 units/L (reference range, 50 to 325 units/L) was observed in a