Serum creatine kinase activity following a 120-km march

Case series: hyponatremia associated with moderate exercise

Exercise-induced hyponatremia is commonly believed to be associated only with extraordinary physical efforts, or particularly strenuous exercise. Hyponatremia complicating moderate exercise has not been described previously. The authors describe the characteristics of seven patients with life-threatening hyponatremia associated with mild to moderate exercise. All patients suffered from nausea, vomiting, agitation, and confusion, appearing during or after moderate physical activity. Grand mal convulsions occurred in five of the patients. In laboratory results, hyponatremia was as low as 115 mEq/L, with a relatively high sodium concentration in the urine. High serum creatine kinase activity levels were found in most of the patients. All patients were discharged in good condition, without neurologic sequela. The authors conclude that hyponatremia is a possible complication of moderate exercise, and not only of endurance sports, and that exercise-induced hyponatremia can produce severe neurologic manifestations. The mechanism of the hyponatremia is unclear, but may be due to a hemodynamically inappropriate stimulus for antidiuretic hormone secretion.

Cardiovascular and muscular strain during a tree planting season among British Columbia silviculture workers

Cardiovascular and muscle strain were determined in 16 British Columbia reforestation workers during a period of tree planting (75 days). Serial data collected from each worker included pre- and post-work blood chemistry on the first day of the work shift; working heart rate (HR), a PWC170 fitness test, and a daily diary of an individual's work-rest schedule. Repeated blood samples from each planter were analysed for the elevated serum enzyme activities (ESEA) of creatine kinase (CK), lactate dehydrogenase (LDH), and aspartate transaminase (AST), and for the blood haematology parameters (BH) of haematocrit (Hct), red blood cell count (RBC), and haemoglobin (Hgb). HR and BH were used as an index of cardiovascular strain and ESEA was used as an index for musculoskeletal strain. A group mean working heart rate of 116.5 +/- 9 b.min-1 (range 100.0-139.1) was sustained throughout the period of an 8.0 hour day representing 39.2% of the delta Heart Rate ratio (ratio of elevated working Hr above resting to maximum HR). Grouped data were analysed by sample day for a subset of planters (n = 10) participating in six sample dates during the first 32 days of planting. Pre- and post-work ESEA were significantly higher throughout the entire planting period when compared with a pre-season resting control group (n = 9, p < or = 0.01). The post-work rise in CK and AST from pre-work values decreased during successive weeks of work as some adaptation to the work rate occurred. LDH continued to rise and was significantly elevated on day 32 compared with day 1. No significance was found in the BH variables between sample dates, yet a decreasing trend was observed. However, pooled data from all subjects for all sample dates showed a highly significant difference (p < or = 0.01) between pre- and post-work samples for both ESEA and BH. ESEA increased and BH decreased. These data present evidence that the work rate and rest time of a tree planter are not well ordered within the daily and seasonal working routine, and may compromise worker well-being in the silviculture industry.

Elevated serum CK in long abstinent cocaine abusers

In preparation for an exercise program in cocaine abusers maintained abstinent in a hospital setting (average 98.4 days), we measured resting serum creatine kinase (CK). Surprisingly, many were elevated. Further tests confirmed the observation. We measured 19 long abstinent cocaine abusers, 22 abstinent abusers of other substances, and a later group of 26 long abstinent cocaine abusers. While none of the other substance abusers showed elevated serum CK levels, 53 and 31% of the abstinent cocaine groups did (p = .000082 and .00041, respectively). All CK elevations were muscle derived; repeated sampling demonstrated stability. Cocaine abusers' CK showed a bimodal distribution: the lower bell curve approximated controls and the higher bell curve centered above normal range, at 400 U/L. Demographics did not influence the results. With complementary findings of impaired spatial motor performance, these persistent CK elevations suggest that a large minority of cocaine abusers maintain tendencies to coarse motor control and impulsive movements, and perhaps hyperactivity.

Serum carbonic anhydrase III, an enzyme of type I muscle fibres, and the intensity of physical exercise

The effects of 30 min running with stepwise increasing intensity (exhaustive, energy demand approx. 50----100% of VO2max), 60 s supramaximal running (anaerobic, greater than or equal to 125% of VO2max) and 40-60 min low-intensity running (aerobic, 40-60% of VO2max) on serum concentration of muscle-derived proteins were studied in 5 male and 5 female elite orienteerers. S-Carbonic anhydrase III (S-CA III) was used as a marker of protein leakage from type I (slow oxidative) muscle fibres and S-myoglobin (S-Mb) as a non-selective (type I + II) muscular marker. The fractional increase in S-CA III (delta S-Ca III) was 0.37 +/- 0.09 (mean +/- SEM, p less than 0.001), 0.10 +/- 0.05 (N. S.) and 0.46 +/- 0.09 (p less than 0.001) 1 h after exhaustive, anaerobic and aerobic exercise, respectively. The corresponding values for delta S-Mb were 1.45 +/- 0.36 (p less than 0.001), 0.39 +/- 0.13 (p less than 0.01) and 0.67 +/- 0.18 (p less than 0.001). The value for the delta S-CA III/delta S-Mb ratio was 0.68 +/- 0.03 after the aerobic exercise, but only 0.25-0.26 (p vs. aerobic exercise less than 0.001) after the two high-intensity forms of exercise. Since type I fibres of skeletal muscle are known to be responsible for power production during low-intensity exercise, whereas fibres of both type I and type II are active at higher intensities, the delta S-CA III/delta S-Mb ratio may depend on the recruitment profile of type I vs. type I + II fibres.

Prediction of physical performance through muscle enzymes activity

Physical performance deteriorates during strenuous exercise as manifested by a decrease in maximal aerobic power and increased activity of serum muscle enzymes. The relationship between these parameters was investigated in 41 trained subjects during 24 h marches and the following recovery period. Peak O2 uptake and serum activity of creatine phosphokinase (CPK) and glutamic oxalacetic transaminase (GOT) were measured. During the marches there was a simultaneous, significant elevation in serum CPK and GOT activity and a significant reduction in peak O2 uptake. During the early recovery period (24 h) no significant changes occurred in muscle enzyme activity and peak O2 uptake; thereafter (up to 72 h after the end of the march), a gradual decline in enzyme activity levels with a concomitant increase in peak O2 uptake was observed, reaching pre-march values. A "mirror image" relationship between muscle enzyme activity and peak O2 uptake was found during three clearly distinguished phases: a) 24 h march, b) early recovery stage and c) late recovery stage. These findings suggest that muscle enzyme leakage from muscle cells is closely related to the decline in muscular function and aerobic power. Thus, muscle enzyme activity might be a practical measure of physical performance capacity during the early and late stages of recovery from prolonged endurance exercise.

Enzymatic and hormonal responses following a 24 h endurance run and a 10 h triathlon race

Muscle cell leakage and hormonal changes were compared immediately after and during the 3 days following a 24 h endurance run (R24h) in 8 subjects, and a 10 h triathlon non-competitive race (T10h) in 6 subjects. The study showed three main differences: 1) plasma enzyme increases were considerably more significant in R24h than in T10h: compared with resting levels, creatine kinase increased x 120 after R24h but only x 2 after T10h; lactic dehydrogenase x 4, as opposed to x 1.5; and transaminases only showed an increase after R24h. The plasma myoglobin increase after R24h was double that found after T10h; 2) for the same magnitude of plasma aldosterone and cortisol after R24h and T10h (3 times the resting levels), a highly significant decrease in urinary Na+ (p less than 0.001) and an increase in urinary K+ (p less than 0.01) were found only after R24h; and 3) the plasma free noradrenaline level increased significantly after R24h (x 2.6) whereas it was unchanged after T10h. In contrast, the plasma level of conjugated dopamine increased only after T10h (x 3.7, p less than 0.05). These results suggest that long-distance running causes more muscular lesions than the triathlon, and that important factors other than aldosterone are probably involved in the regulation of urinary electrolyte excretions during T10h.

Carrier detection in Duchenne muscular dystrophy: a review of current issues and approaches

The clinical chemistry laboratory has traditionally played a passive role in the application of technology to diagnostic interpretation. Recent developments offer the clinical laboratorian a renewed potential to enter the patient care arena as a consultant. Our lack of understanding of the disease processes in the muscular dystrophies places emphasis on prevention through carrier detection. This review summarizes the clinical progress of the disease, our present understanding of the genetics that control the mode of inheritance of the disease, and the analytical approaches to carrier detection, including their advantages and limitations. Recent advances allow the examination of the genetic material itself instead of concentrating on the phenotypic expression of biochemical abnormalities.