Hypophosphatemia

Hypophosphatemia is a condition wherein the blood phosphorus levels fall below 0.8 mmol/L. The normal blood phosphorus range is about 0.8 to 1.4 mmol/L in adults and slightly higher in children. Phosphorus plays an important role in energy formation and storage, nerve conduction, kidney function and formation of teeth and bones. Good dietary sources of phosphorus include meats, whole grain breads and cereals.

Typical symptoms of hypophosphatemia include bone pain, muscle weakness, confusion, seizures and anemia. Muscle cramps and Rhabdomyolysis are other symptoms. Certain medications like birth control pills, anabolic steroids and diuretics can cause hypophosphatemia. Hyperparathyroidism, Vitamin D deficiency and alcoholism can lead to this condition. When the levels of phosphorus fall too low, it can lead to easy bleeding and increased instances of infection. Kidney function test and Vitamin K blood test are conducted. Weak bones might be noticed on X-rays. Anemia and heart damage (Cardiomyopathy) is sometimes noticed.

CK blood test

A Creatinine Kinase test is a blood test that measures the levels of Creatinine phosphokinase (CPK). It is an enzyme found predominantly in the heart tissue, brain and skeletal muscle. The CK blood test is commonly used to diagnose the existence of heart muscle damage. The CK blood test result shows an increase above normal in a person's blood test about six hours after the start of a heart attack.

It reaches its peak in about 18 hours and returns to normal in 24 to 36 hours. When the total CPK level is substantially elevated, then it is indicative of injury or stress to heart, brain or skeletal areas. The small amount of CPK that is normally in the blood comes from the muscles. The CPK blood test also helps in cost-effective management of people with suspected coronary atherosclerosis. It also evaluates the extent of muscle damage caused by drugs, trauma or immobility.

Abnormal CK-MB (one of three CK isoenzymes) or troponin levels are associated with Myocyte Necrosis and the diagnosis of Myocardial infarction. The Cardiac Markers of Cardiac Myocyte Necrosis (damage to the Cardiac muscle cells), myoglobin, CK, CK-MB and troponin I and T are primarily used to identify acute Myocardial Infarction.

It is used in early detection of dermatomyositis and polymyositis. It is also used to distinguish malignant hyperthermia from a post operative infection. It helps to discover carriers of muscular dystrophy.

The normal range for Creatinine Kinase (CK or CPK) blood test:
Male: 38 - 174 units/L
Female: 96 - 140 units/L

Increased levels of CK also can be found in viral myositis and hypothyroidism. Higher than normal CPK levels is indicative of the following conditions:

• Heart attack
  
• Myocarditis
  
• Convulsions
  
• Delirium Tremens
  
• Electric shock
  
• Muscular dystrophy
  
• Pulmonary infarction
  

CK MB

Serum CKMB levels are tested to check for myocardial injury. It is another important cardiac marker. The primary source of CKMB is myocardium although it is also found in skeletal muscle. Typically CKMB tests have now been replaced by Troponin test. But in cases of abnormal Troponin assay results or suspected re-infarction in the hospital, the CKMB serum test is still used.

High levels of CK MB are noticed in cases of polymyositis and rhabdomyolysis. Patients suffering pulmonary embolism, hypothyroidism, and muscular dystrophy or carbon monoxide poisoning can also show higher levels of serum CKMB. The reference range is about 56.2 pg/mL.

Wernicke Korsakoff Syndrome : Wernicke Korsakoff Syndrome is primarily caused by the deficiency of thiamine, (Vitamin B1) usually due to chronic alcohol abuse. But Korsakoff Syndrome can have other origins other than alcohol abuse - chronic vomiting that may inhibit the absorption of Thiamine.

Neurological complications of alcohol abuse may also result from nutritional deficiency exacerbated by the excessive intake of alcohol which depletes Vitamin B1 - thiamine essential for normal nervous system. Sudden changes in blood chemistry specifically sodium, may cause central pontine myelinolysis, a condition of the brainstem in which nerves lose their myelin coating. Other complication include Liver disease and alcoholic cirrhosis.

Such conditions - if left untreated can progress to the onset of Wernicke encephalopathy - whose symptoms include marked confusion, delirium, disorientation, memory loss and drowsiness. Physical Examination may reveal abnormalities of eye movement, jerking of the eyes (nystagmus) and double vision. Even walking may seem hard to do as the patient has problems with balance and muscular co-ordination. If thiamine is not administered soon Wernicke encephalopathy may progress to stupor, coma and death.

If Thiamine is administered in time, the patient may escape from death but Korsakoff’s syndrome may still leave him/her crippled from permanent memory impairment - some may not remember events for a period of a few years before the onset of illness (retrograde amnesia) and unable to learn new information (anterograde amnesia).
Repeated episodes of Encephalopathy and/or prolonged alcohol abuse may lead to Korsakoff psychosis a form of dementia.

Alcoholic myopathy or muscular weakness due to breakdown of muscle tissue, is called as alcoholic rhabdomyolysis or alcoholic myoglobinuria. Usually men are affected by alcoholic myopathy about 4 times as often as women. Breakdown of muscle tissue (myonecrosis), can occur at any time during binge drinking or in the first days of alcohol withdrawal. Although this itself may not result in any apparent symptom in the initial stages, it can still be detected by temporary elevation in blood levels of an enzyme the MM fraction of creatine kinase - found in muscles.

Wernicke Korsakoff syndrome also known as Cerebral Beriberi, usually occurs in chronic alcoholics and affects the central nervous system (brain and spinal cord). It can be caused by a situation that aggravates a chronic thiamine deficiency, like an alcoholic binge or severe vomiting.