[A high serum creatine kinase picture due to too much or too little exercise]

In case I, a 31-year-old man who had undergone unusual high-performance training, painful swellings occurred in the left arm and creatine kinase activity was raised (28,644 U/l), as well as that of the transaminases. A rapid urine test for blood was positive, but the sediment was free of red blood cells. There were no other pathological findings. Fluid intake was increased to 31 daily and on the third day he was symptom-free and creatine kinase activity had fallen to 6475 U/l, reaching normal values on the 15th day. Case 2 concerned a 28-year-old woman with paranoid schizophrenia who had taken several tablets of clozapine and then remained in bed for 3 days. She complained of pain in the region of the gluteus maximus muscles, exacerbated on pressure but otherwise unremarkable. Creatine kinase was raised to 21,492 U/l, creatine to 186 mumol/l, and the transaminases were likewise increased. The urine strip-test for blood was twice positive. She was treated with frusemide (80 mg daily) and infusions of electrolyte solution (21 daily). She became pain-free on the second day and the various enzyme activities rapidly fell to normal.