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Thursday, September 1, 2016
Elevated AST, CK, AlkP
My son is 9 years old. We took him in to the pedi on Wednesday because he was having pain in his legs and trouble walking. 4 days prior we had completed a strenuous hike to the top of a waterfall and that night he had a fever of 102 and a headache. He was sick for two more days with fever, headache, cough, minor sore throat. He returned to school the day before we took him to the doctor and had an "exercise test" in PE in which he had to run and do pull-ups, etc.
At the doctor`s office, lab work revealed a highly elevated creatine kinase, total, serum of 3663 and AST of 164 with BUN/Creatinite Ratio of 35.
Two days later I took him back and requested that additional lab work be done. His CK had lowered to 987, AST to 119. His AlkP was 160.
Could these lab results be due to the excessive exercise he had done with the hiking and PE test. The PE test was one day prior to the first labwork and three days before the last labwork. Given that he had also had a fever, runny nose, cough, sore throat, etc. could this also have contributed to dehydration possibly?
My fear is muscular dystrophy which both doctors mentioned and referred us to a neurologist. Of course I want to go and get his opinion, but I would also like to know if all of these factors together could possibly have contributed to this type of elevated lab results?
Thank you very much for the question. I am sure it was very concerning to you that your son had laboratory evidence of muscle breakdown. Certainly, physical exertion, particularly in the heat, can lead to an elevation in muscle enzymes. Also, a number of viral infections (ie. influenza, parainfluenza, coxsackievirus, and others) can also lead to muscle enzyme elevation as well other symptoms, such as fever, cough, and headache. Your son's laboratory studies may have arisen from physical exertion and a viral infection. You son's pediatrician and neurologist will likely investigate other potential causes. Thank you again for the question.
Stephen E Wilson, MD, MSc
Assistant Professor of Clinical Medicine
College of Medicine
University of Cincinnati