Hypokalemic Myopathy and Elevation of Serum Enzymes

Abstract

THE MEASUREMENT of serum en$ zyme activities, particularly those of crea$ tine phosphokinase (CPK), aldolase, and glutamic oxaloacetic transaminase (SGOT), is an important adjunct in the diagnosis of primary muscle disease.1-4 Elevations have been found in patients with muscular dystrophy and polymyositis,5-7 whereas patients with neurogenic atrophy generally have had normal levels.8Altered potassium metabolism has long been associated with muscle dysfunction,9 but only a few references have appeared linking hypokalemia, myopathy, and serum enzyme elevation.10-12 Three patients with hypokalemia and severe muscle weakness were studied; all had marked alterations in their serum enzymes, particularly CPK. MethodsCreatine phosphokinase determinations were done using the method of Nielsen and Ludvigsen.13 The normal range is 0\g=m\Uto 18\g=m\U per milliliter.Glutamic oxaloacetic transaminase determinations were performed using a modification of the method of Henry and co-workers.14 The normal values are in the range of 10\g=m\Uto 35\g=m\U per milliliter. Aldolase determinations were based on the method of Beisenherz and co-workers15 and the normal values are 3/iU to 8µ per milliliter.Serum potassium values were determined by flame photometry. Normal range is 3.9 to 5.2 mEq/liter ± 0.2 mEq/liter. Muscle strength was evaluated daily by one, and often by two, of the authors. Strength was graded according to the method used by Smith et al16 where 5 is normal and 0 represents no observed activity.

Creatine Phosphokinase-Linked Immunoglobulin in a Patient with Hypokalemic Myopathy

“…Although oral potassium supplements were continued and the serum K level was kept in the normal range, the patient's proximal muscles remained weak and tender despite a steady trend toward full recovery. Although no underlying diseases or medicines to produce severe potassium depletion were identified, the neurological and laboratory findings were consistent with well-documented descriptions of hypokalemic myopathy [8,9]. This patient presented herein is the first to document a possible association between hypokalemic myopathy and macro-CPK type 1.…”

Hypokalemic Myopathy Associated with Radiation Enteropathy

“…There are many underlying disorders which can cause hypokalemic myopathy, for example, primary aldosteronism [10], chronic alcoholism [6], renal tubular acidosis [12], 17a-hydroxylase deficiency [14], villous adenoma of the intestine [11], ileal resection [1], and several medications such as diuretics [12], laxatives [12], glycyrrhiza (licorice) [2], and amphotericin B [8], Most of the disor ders are related to renal or intestinal potas sium loss. In this particular case, hypokal emia was most likely induced by the intesti nal potassium loss due to chronic diarrhea.…”

“…Hypokalemic myopathy is characterized by muscle weakness associated with hypokal emia, and the symptoms improve when the hypokalemia is corrected [12]. Here we present a case of hypokalemic myopathy as sociated with chronic diarrhea caused by ra diation enteropathy.…”

A case of hypokalemic myopathy associated with transient hypothyroidism.

“…Microscopic findings such as vacuolation and Z line streaming are compatible to hypokalemic myopathy (Van Horn et al, 1970). On the other hand, decreased serum potassium levels have been known to suppress secretion of some hormones such as GH from the pituitary (Meckenberg et al, 1974) and insulin from the pancreatic islets (Conn, 1965).…”