Muscle Enzymes Creatine Kinase and Aldolase

Creatine kinase (CK) is an enzyme produced by skeletal muscles, the heart muscle, and the brain. Although it may be elevated in adults who have recently suffered a heart attack, the most frequent cause of elevations in childhood is muscle inflammation. This may occur in children with dermatomyositis, scleroderma, or mixed connective tissue disease. Sometimes the CK is elevated with extensive exercise, but in these children the level goes back to normal after two weeks' rest. The level of CK is also elevated after some viral infections. Some children have elevated CK levels that persist despite rest and for which no explanation can be found; see Chapter 14, on dermatomyositis.

Aldolase is another muscle enzyme that may be elevated in children with muscle damage. In general, the aldolase is less sensitive to muscle inflammation than the CK, but there are children with dermatomyositis who have elevated aldolase levels and a normal CK. Aldolase can also be increased in children with liver inflammation secondary to infectious mononucleosis or viral hepatitis.

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