Differential diagnosis importance of the creatine kinase isoenzyme pattern in delirium tremens

Total CK and CK-MB (by the inhibition test, Merck-1-CK-MB) were measured in 33 patients which had to be admitted to the department of psychiatry due to acute withdrawal symptoms (predelirium, delirium) caused by chronic alcohol abuse. The results were evaluated together with the routinely performed laboratory determinations as well as clinical examination and morphologic investigations (ECG, X-ray examination of the thorax, EEG, CT). The results show that the CK-MB/total CK relationship represents also in these patients the most reliable parameter to discriminate elevated total CK values. In no but one case a substantial CK-BB release from the central nervous system could be demonstrated by the inhibition test. In 83% of the patients with elevated total CK activities it was possible to exclude an affection of the heart muscle (CK-MB portion below 6%). The CK-MB/total CK-quotient was clearly superior to the total CK/GOT relationship, by which a myocardial affection could be excluded in less than 40%. In four patients the CK-MB portion was above the critical decision limit of 6%: three obtained between 6% and 7%, one even 17%. The results suggest that the CK-MB/total CK-quotient may represent the most sensitive and reliable parameter of myocardial affection in patients with an alcohol intoxication and/or a delirium tremens.