Sheryl, an active 78-year-old, suddenly became greatly fatigued and disoriented
ID: 3509250 • Letter: S
Question
Sheryl, an active 78-year-old, suddenly became greatly fatigued and disoriented while skiing. When she was brought to the hospital, blood tests revealed elevated levels of LDH, AST, ALT, and the MB isoform of CK.
Some of the new terms and concepts you will encounter include:
Enzymes, isoenzymes, coenzymes, and cofactors
LDH, AST, ALT, and CK
Sheryl's blood tests reveal elevated levels of CPK, LDH, AST, and ALT.
What enzymes do these letters indicate, and what diseases do elevated blood levels of these enzymes suggest? (Check Table 4.1 in your book)
How might these test results relate to Sheryl's symptoms?
Sheryl had an elevated level of the CK-MB isoenzyme of creatine phosphokinase.
What are the different isoenzymes of CK, and what is their medical significance?
What is the most likely explanation of Sheryl's symptoms and laboratory findings?
Explanation / Answer
1. CPK stands for Creatinine Phosphokinase.
LDH stands for Lactate Dehydrogenase
AST stands for Aspartate aminotransferase
ALT stands for Alanine aminotransferase
Increase in the level of CPK suggests muscular dystrophy and mycocardial infarction
increase in the level of LDH suggests myocardial infarction, liver disease, renal disease, pernicious anemia
increase in the level of AST and ALT suggets myocardial infarction, hepatitis, muscular dystophy
2. As Sheryl showed the symptoms of fatigue and disorientation, and her test results showed an increase in the level of LDH, AST, ALT and CPK MB. This shows that Sheryl actually suffered from myocardial infarction because the level of these enzymes increase during a heart attack.
3. The different isoenzymes of CK are CK-BB (or CK-1), CK-MB (or CK-2) and CK-MM ( or CK-3).
CK-BB is released into the bloodstream from damaged brain and lungs.
CK-MB is released by the damaged cardiac muscle during myocardial infarction.
CK-MM is released by the damaged skeletal muscle.
4. The most likely explanation is that Sheryl suffered from myocardial infarction due to damage in her cardiac muscles, which lead to an increase in the level of CPK MB, LDH, AST and ALT enzymes.
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