Muscle weakness in all limbs.

Chief Complaint A 72 y/o male presents with muscle weakness in all 4 limbs. History Lab reports shows increased liver enzymes. CT abdomen shows peripancreatic tumor mass. Resection was done. After 3 months patient become bed ridden & unable to walk. Investogations Ct abdomen and chest is wnl. Creatine kinase level 5998 U/l (normal range <70), LDH: 2899 U/l (250–420), AST: 579 U/l (10–30), alanine aminotransferase: 893 U/l (10–30). Tumor markers, CSF were wnl. What other investigations should be done now? Treatment Please give your opinion.


Elevated Createnine kinese level gives hint to special pathophysiology. The muscle cells in your body need CK to function. Levels of CK can rise after a heart attack, skeletal muscle injury, or strenuous exercise. They can also go up after drinking too much alcohol or from taking certain medicines or supplements. CK stands for creatine kinase, an enzyme that leaks out of damaged muscle. When elevated CK levels are found in a blood sample, it usually means muscle is being destroyed by some abnormal process, such as a muscular dystrophy or inflammation. Hormonal disorders, including disorders of the thyroid and adrenal glands...Blood clots....Infections.. Some medicines.. triggered the situation. Electromyography, nerve conduction studies, or muscle biopsy, or a combination of these tests, is usually needed to investigate neuro-muscular causes of elevated CK.

Increased CK-mB and other enymes Likely a c/o rhobdomyelosis With muscular dystrophy as he is a c/o peripancreatic tumor and undergone surgery a triggering point Do KFTS Look for cholestrol and lipid profile Is pt is on OHA like canagliflizone+rosuvastatin likely to potentiate rhobdomyelosis Second point to explore periportal tumor spreading to brain Wether pt was diabetic and on insulin or otherwise freshly detected diabitic What was peripencreatic tumor Si many points to study and workout

Thanx dr Rajalaxmi Pujahari

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Such a high level of creatine phosphokinase also called as creatine kinase and commonly pronounced as CPK , is very rare It is commonly associated with severe sepsis, critically ill patients, rabdomyolysis caused by side effect of medicines, neuroleptic malignant syndrome and malignant hyperthermia It raised value indicate damage to muscle and indicates that patient is critically ill Therefore one may look for Sepsis Severe infection Medicines causing rabdomyolysis - antipsychotic medication, atorvastatin Basically


Sir, I think needs CBC, SODIUM, POTASSIUM, BUN, BS(F), PP, HbA1c, LFT, LIPID PROFILE for further evaluation. Other wise consult with Gastroenterologist and Urologist for the better treatment and management.

Thank you Sir@Dr. Ashok Leel .

when creatinine kinase is elevated,check for things like rhadbdomyolysis, check for electrolytes give fluid rehydration check for urine output check for bedsores

* Rhabdomyolysis Removal of pancreas due to pathology may create some hormonal imbalance that effect the functions of various organs with leads to reduction of blood flow and conduction to the muscles and organs.there complete and comprehensive studies needed to be conclusive. Start from doppler angiography to hormonal profile and clinical test.

Looks Muscular dystrophy with peripancreatic mass ? Malignant and sec to liver D/d viral myosotis Rhabdomyolysis

Diabetic diet. Starvation should also be ruled out

Creatinine kinase Muscle dystrophy known Liver enzymes high Low protein diet Chitoson diet Water restrictions

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