Creatine Kinase, Total Serum

Methodology: 
Kinetic − 340 nm spectrophotometric
Performed: 
Monday - Friday
Use: 
This test is used in the diagnosis of acute myocardial infarction and skeletal muscular damage.|
 

Limitations

Intramuscular injections increase serum CK activity. Elevated following exercise. Normal at onset of acute MI unless the subject has been exercising or doing physical work. Elevation of CK following acute MI may not be observed until six or more hours after onset. CK returns to normal in approximately 48 to 72 hours after acute MI. Total CK can be normal in acute MI, when CK-MB is increased. Low CK does not rule out myositis in patients with the connective tissue diseases.7 CK is shown to be decreased in pregnancy.

Specimen Requirements: 
Type: Serum (preferred) or plasma
 

Container/Tube: Red-top ttetsstic − 340 nm spectrophotometric

Minimum Volume: 0.4 mL

Storage: Specimens must be maintained at room temperature.

Stability (from collection to sample testing):
  • Ambient: 14 days
  • Refrigerated: 14 days
  • Frozen: 14 days
  • Freeze/Thaw Cycles: Stable (x 3)
Rejection Criteria:
  • Hemolysis
Special Instructions: Indicate the patient's gender on the requisition form.
CPT Code (s): 
82550
Notes: 

UFHPL Test #: 28055

UFHPL Epic order code: LAB62

  • Patients should avoid exercising before specimen collection.
     
  • The duration of the immediate postoperative period following surgical procedures involving incision through muscle may be prolonged.

High CK is found after trauma, surgery and exercise; in these cases, there may not also be an elevation of CK-MB. To distinguish myoglobinuria from hemoglobinuria, serum CK and LD may be helpful. CK is normal with uncomplicated hemolysis, but LD and LD1 are typically increased. When myoglobin is released, 40-fold elevation of CK may be anticipated with only moderate increase in serum LD and increased LD5.8

References

  1. Rosalki SB. Serum enzymes in disease of skeletal muscle. Clin Lab Med. 1989 Dec; 9(4):767-781. PubMed 2686911
  2. Kilbourne EM, Swygert LA, Philen RM, et al. Interim guidance on the eosinophilia-myalgia syndrome. Ann Intern Med. 1990 Jan 15; 112(2):85-87. PubMed 2153013
  3. Roth D, Alarcón FJ, Fernández JA, Preston RA, Bourgoignie JJ. Acute rhabdomyolysis associated with cocaine intoxication. N Engl J Med. 1988 Sep 15; 319(11):673-677. PubMed 3412385
  4. Eng C, Skolnick AE, Come SE. Elevated creatine kinase and malignancy. Hosp Pract (Off Ed). 1990; 25(12):123,126,129-130. PubMed 2123205
  5. O'Neill PG, Faitelson L, Taylor A, Puleo P, Roberts R, Pacifico A. Time course of creatine kinase release after termination of sustained ventricular dysrhythmias. Am Heart J. 1991 Sep; 122(3 Pt 1):709-714. PubMed 1877446
  6. Nanji AA, Blank D. Low serum creatine kinase activity in patients with alcoholic liver disease. Clin Chem. 1981 Nov; 27(11):1954. PubMed 7296863
  7. Wei N, Pavlidis N, Tsokos G, Elin RJ, Plotz PH. Clinical significance of low creatine phosphokinase values in patients with connective tissue diseases. JAMA. 1981 Oct 23-30; 246(17):1921-1923. PubMed 7288967
  8. Faulkner WR. Update on myoglobinurias. Lab Report for Physicians. 1989; 11:91-92.
Collection procedure: 
  • Separate serum or plasma from cells.
  • Avoid prolonged contact of serum or plasma with red cells.
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