Creatine Phosphokinase

Aka: Creatine Phosphokinase, Creatine Kinase, Creatine Phosphotransferase, CPK, CK-MB, CK-MM ( C0010291), CK-BB

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II. Physiology

  1. Transferase class enzyme activated by Magnesium
  2. Catalyzes ATP energy storage as Phosphocreatine
  3. Phosphocreatine stored in Muscle and brain
  4. Phosphocreatine keeps ATP constant at Exercise start

III. Increased

  1. Myocardial Infarction
  2. Myocarditis
  3. Rhabdomyolysis
  4. Myositis
  5. Crush injury or Trauma
  6. Dermatomyositis or Polymyositis
  7. Muscular Dystrophy
  8. Myxedema (Hypothyroidism)
  9. Seizure
  10. Malignant Hyperthermia
  11. Intramuscular Injections
  12. Cerebrovascular Accident
  13. Pulmonary Infarction
  14. Pulmonary Embolus
  15. Acute Aortic Dissection
  16. Vigorous Exercise
    1. CPK levels increase with common exertional activities (e.g. >20x normal at 1 day after marathon)
    2. Siegel (1981) JAMA 246(18): 2049-51 +PMID: 7288991 [PubMed]
    3. Kenney (2012) Muscl Nerve 45(30: 356-62 +PMID:22334169 [PubMed]
    4. Clarkson (2006) Med Sci Sports Exerc 38(4): 623-7 +PMID:16679975 [PubMed]

IV. Isoenzymes:

  1. MB: Heart
  2. MM: Skeletal Muscle
  3. BB:
    1. Brain
    2. Bowel infarction
    3. Neoplasm (Prostate, GI, Breast, Ovary, Lung, Brain)

V. Protocol: Acute Coronary Syndrome Evaluation (listed for historical reasons)

  1. Older protocol - replaced in United States with Troponin
  2. Obtain Serial CPK every 6 hours for total of 3 values
  3. Fractionate to CK-MB only if CPK increased
  4. CK-MB >5% of total CPK suggests Myocardial Infarction

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