February Case Of The Month

Title: Chronic Elevated CPK

 

       An anesthesiologist from Florida was to give anesthesia to a 46 y/o male for Hip Arthroplasty in a few days and he has a chronic CPK level of 1000 to 1500. He is a smoker and has a history of cocaine and alcoholo abuse.  The question was is the patient susceptable to MH and should she do a non-trigering technique? Should he be sent for MH testing?

 

Questions:


1.  Chronic elevation of CPK can be seen with?

                  A. muscle diseases

                  B. arthritis, chronic pain syndrome

                  C. Statin cholesterol reducing drugs   

                  D. Chronic cocaine or alcohol use 

                  E. All of the above

 

2.  What other disease states are associated with Chronic elevated CPK levels?

                 A. Mental illness, psychosis

                 B. Myositis

                 C. Strenuous exercise, weight lifting

                 D. Polymyalgia rheumatica 

                 E. All of the above 

 

3.  Should he be sent for MH testing?

                 A. yes

                 B. no

 

Answers:  

 

1.  E

2.  E

3.  No  

 

Discussion:  BA Britt wrote an article: Screening of MH susceptible families by CPK measurement and other clinical investigations in Canadian Anaesthesia Society Journal, 1976 May;23(3):263-4. Britt investigated 56 families with MH. Serum CPK was statistically higher in affected individuals and close relatives than normal volunteers. The magnitude of the elavated CPK was variable, some had no elevation, some had mild elevation. Britt thought CPK values were of little help or no value in identifying susceptable individuals. Not all families had elevated CPK.

         The list of associated diseases and causes of chronic CPK elevation is large. The patient from Florida used cocaine and alcohol, both of which is associated with elevated CPK levels. Chronic elevation of CPK can be seen with antilipid drugs, androgen therapy, licorice, weight lifting, extreme exercise, muscular dystrophy, myositis, chronic pain patients, fibromyalgia, mental illness, psychosis, arthritis, viral infections, brain injury, obstructive sleep apnea and many more.

           I told the Hotline caller that the elevated CPK would not rule in or out the liklihood of her patient having MH. I told her the alcohol and cocaine could be the cause of the elevated CPK.       

James Chapin, MD
University of Nebraska Medical Center
Omaha, NE