Alterations in Serum Creatine Kinase and Lactate Dehydrogenase: DISCUSSION

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Previous experimental studies have shown that mesenteric infarction causes an elevation of serum total С К within the first 24 hours after an infarction. The three isoenzymes of С К also become elevated within that same time period. The majority of the enzyme elevation is CK-MM, with CK-MB and CK- BB being present but being substantially less than the amount of CK-MM present. Clinical evaluation of the CK tracings in the patients that had MES INF showed that these patients had elevations of serum total С К in the first 24 hours as did the patients who had major aortic reconstructions and AMI. All three groups went above the upper limit of normal (100 IU/L) for our laboratory within this time frame. Differentiation between these three groups of patients based on this measurement was not possible.

Because serum CK-MB has been shown to rise dur­ing the latter portion of bowel infarctions, particularly in those experimental subjects who have lethal infarc­tions, analysis of serum CK-MB was conducted both in terms of percentage of the total and in terms of international units per liter found in the serum. Serum CK-MB became elevated above the upper limits of normal (5 percent) in the group of patients who had AMI and those having acute bowel infarctions (Fig 2). Differentiation between the group of patients having AMI and the one with bowel necrosis was not possible based on the CK-MB percentage present in the peripheral serum because the values were similar in two of the three time periods within the first 36 hours after the clinical events. Overlap between these two groups became more apparent in the subsequent course. Differentiation of the groups of patients with either bowel or myocardial infarctions from the group undergoing AAS was possible since the CK-MB per­centage remained below 5 percent in this group.

Analysis of the serum CK-MB in terms of interna­tional units per liter showed that the group with bowel necrosis and the one with AMI had similar values during the second and third days after their clinical events. Patients who had necrotic bowel had values based on this determination during the first day after onset which were closer to those seen after major aortic reconstruction. Differentiation of the patients with necrotic bowel from those who had aortic recon­struction was possible on the second and third day (Fig3).
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One of the most important measurements for dif­ferentiating bowel necrosis from myocardial infarction appears to be serum CK-BB elevations seen after bowel infarction. This isoenzyme was not found in any of the patients who had major aortic reconstructions nor in any of those patients who had AMI. This band may be present in patients who have chronic renal failure, metastatic cancers, had recent cerebral vas­cular accidents, and have experienced major central nervous system trauma. These conditions obviously can be differentiated from bowel infarction on a clinical basis.