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Creatine Kinase

Muhammad Asif Zeb


Lecturer MLT
Institute of Paramedical Sciences
Peshawar.
Creatine Kinase
o CK is an enzyme with a molecular weight of
approximately 82,000
o It is generally associated with ATP regeneration
o Its predominant physiologic function occurs in
muscle cells, where it is involved in the storage of
high-energy creatine phosphate.
o Every contraction cycle of muscle results in
creatine phosphate use, with the production of ATP.
CK/
CPK
Creatine
Creatine Phosphate
ATP ADP
(Energy source for muscle contraction)
LOCATION
CK is widely distributed in tissue
Richest Sources
oSkeletal muscle,
oHeart muscle, and
oBrain tissue.
CK is present in much smaller
quantities in other tissue sources,
including the bladder, placenta,
Gastrointestinal tract, thyroid, uterus,
kidney, lung, prostate, spleen, liver, and
pancreas.
Creatine Kinase (CK/ CPK) Isoenzymes:-
CK1 (CK-BB) brain type: is the characteristic
isoenzyme in brain, also found in bladder, GIT ,
uterus and prostate and is 0% of the normal total
serum CK.
**It increases in brain tumors.
CK2 (CK-MB) hybrid type: accounts for about
35% of the CPK activity in cardiac muscle , but less
than 5% in skeletal muscle and <6% of total CK)
**It increases in heart diseases.
Following myocardial infarction, the CK-MB levels
begin to rise within 4 to 8 hours, peak at 12 to 24
hours, and return to normal levels within 48 to 72
hours. This time frame must be considered when
interpreting CK-MB levels.
CK3 (CK-MM) muscle type: is the predominant
isoenzyme in muscle and of 94% to 100% of the normal
total serum CK.
**It increases in skeletal muscle diseases
The major isoenzyme in the sera of healthy people is
the MM form.
On electrophoretic separation, CK-BB will migrate
fastest toward the anode and is therefore called CK-1.
CK-BB is followed by CK-MB (CK-2) and, finally, by CK-MM
(CK-3), exhibiting the slowest mobility

Reference Range
Total CK:
Male, 15160 U/L (37C)
Female, 15130 U/L (37C

CK-MB: 6% total CK
CLINICAL SIGNIFICANCE OF
CK/CKP
Because of the high concentrations
of CK in muscle tissue, CK levels are
frequently elevated in disorders of
cardiac and skeletal muscle.
The CK level is considered a sensitive
indicator of acute myocardial
infarction (AMI) and muscular
dystrophy.
CK is often determined routinely in a
medical laboratory. It used to be
determined specifically in patients with
chest pain but this test has been replaced
by troponin.
Creatine kinase in the blood may be high
in health and disease. Exercise increases
the outflow of creatine kinase to the blood
stream for up to a week, and this is the
most common cause of high CK in blood.
High CK in the blood may be an
indication of damage to CK-rich tissue,
such as in rhabdomyolysis, myocardial
infarction, myositis and myocarditis.
Creatine kinase in blood may be elevated
in a wide range of clinical conditions
including the use of medication such as
statins; endocrine disorders such as
hypothyroidism and skeletal muscle
diseases and disorders including
malignant hyperthermia and
neuroleptic malignant syndrome.
The isoenzyme determination has
been used extensively as an
indication for myocardial damage in
heart attacks.
Elevated level of CK is found in:
Skeletal Muscle Disorders such as muscular dystrophy and
Myasthenia gravis
Cardiac Muscle disorders such as Acute Myocardial
Infarction
Elevated CK levels are also occasionally seen in central
nervous system disorders such as:
cerebrovascular accident,
seizures,
nerve degeneration, and central nervous system shock.
Other pathophysiologic conditions in which elevated CK levels
occur are:
hypothyroidism,
malignant hyperpyrexia, and
Reyes syndrome.

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