LACTIC DEHYDROGENASE ELEVATION
LACTIC DEHYDROGENASE ELEVATION: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Questions:
- What is the level of
creatine phosphokinase isoenzyme containing M and B subunits (MB-CPK)
? An elevated MB-CPK combined with elevated LDH is most likely due to a myocardial infarction, although myocarditis and pericarditis can produce a similar picture.
- What is the AST level? If the MB-CPK or CPK are not also increased, an elevation of both the LDH and AST would point to liver disease.
- What are the serum and urine creatine levels? If these are elevated, muscle disease must be considered likely.
- What does the lung scan show? If positive,
a lung scan
separates pulmonary infarction from the other conditions in this group.
DIAGNOSTIC WORKUP
The diagnostic workup should include a CBC, urinalysis, chemistry panel, sedimentation rate, ANA, urine and serum creatine, urine myoglobin, serial EKGs, blood gas analysis, LDH isoenzymes, chest x-ray, lung scan, EMG, and cardiology and neurology consults. A liver scan, CT scan of the abdomen and liver, and muscle biopsy may be necessary.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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ASPARTATE AMINOTRANSFERASE, ALANINE AMINOTRANSFERASE, AND LACTIC DEHYDROGENASE ELEVATION (Differential Diagnosis in Primary Care)
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