![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by mannetje on May 19, 2001, at 12:32:52
Concerned Mom - Question for Cam
My son has an elevated CPK of 229. He had taken seroquel[ 150mg]. His psychiatrist refused to order a blood test telling me that I should see a therapist and stop worrying so I had his MD do one on my own. The CPK was at 3600. The seroquel was stopped and the CPK went down to 229 within a weeek after stopping the seroquel.Sseroquel had been added to 5mgs respirdol which my son has been taking for a year. Now one month later the CPK is still at 229. My son will see a neurologist 6/4/01. What tests should be done? How invasive are they? Should a specialist do them? How will we know if the elevation is due to heart, muscle or brain involvement? Is this NMS? How worried should I be? My son is 31 and diagnosed with schizophrenia. Psychologically he is doing very well. Thank You for responding.
Posted by Cam W. on May 19, 2001, at 13:58:50
In reply to Elevated CPK - Question for CAm, posted by mannetje on May 19, 2001, at 12:32:52
Mannetje - Not to worry, yet. Let the neurologist decide on the tests. You just bring in all your information and history for him. We see transient elevations of liver enzymes quite frequently, but being transient, they do seem to disappear. Many times we only find elevated enzyme levels when we are looking for them. June 4 is not too liong to wait and your son is most likely not in trouble until then, especially if he is psychologically and seemingly physically okay.
I hope this helps - Cam
Posted by Sunnely on May 19, 2001, at 22:40:32
In reply to Elevated CPK - Question for CAm, posted by mannetje on May 19, 2001, at 12:32:52
Hi Mannetje,
I am not Cam but please allow me to express my 2-cent opinion.
Your son's first CPK or CK value of 3600 was indeed signficantly high. Since it went down to 229 with the discontinuation of Seroquel, this was most likely the culprit.
Although your son's current CK value of 229 is slightly above normal, if not accompanied by other symptoms, it is HIGHLY UNLIKELY he has NMS. An elevated CK level alone does not a diagnosis of NMS make. (Some cases of NMS diagnosis were made with normal CK levels.) CK elevation is not a diagnostic laboratory test for NMS. In fact, there is no diagnostic laboratory test for NMS. CK elevation helps support the diagosis of NMS if correlated with other symptoms, such as mutism or catatonic-like reaction, muscle rigidity, high temperature, blood pressure instability (high or low blood presssure), rapid heart beat, profuse sweating.
A person on an antipsychotic drug with an elevated CK + acute central nervous system changes (e.g., confusion, mutism or catatonic-like reaction) + muscle rigidity may indicate that an impending full-blown NMS is about to occur, usually within 24-48 hours, if the antipsychotic is not immediately discontinued. In a study done (if my memory serves me right, by Velamoor et al. 1994) reviewing I believe over 100 cases of NMS, almost 80% of cases of NMS started as confusion, mutism or catatonic-like behavior with muscle rigidity. If recognized at this stage and the antipsychotic immediately discontinued, the symptoms generally reverses with no further complications. If the antipsychotic is continued, the condition usually progresses into the full-blown NMS, a more serious condition with several potential residual complications and higher mortality rate. Death from NMS is usually due to renal failure or aspiration pneumonia.
FYI, virtually all antipsychotics have been reported to cause NMS including the atypical ones (Clozaril, Risperdal, Zyprexa, Seroquel). I have not encountered in the literature, yet of NMS induced by ziprasidone (Geodon) but the possibility exists.
Please be reminded that CK values can rise due to nonmedical reasons such as exercise, agitation, and intramuscular injections. Finally, CK values can be elevated and remain so without any medical explanation.
To reiterate, in your son's case, with a CK value of 229 and without any accompanying symptoms, I highly doubt there is anything to worry about. However, keep that appointment with the neurologist.
Questions of CPK or CK elevations had been asked here a couple times before. You may want to search for this topic for more info.
+++++++++++++++++++++++++++++++++++++
> Concerned Mom - Question for Cam
> My son has an elevated CPK of 229. He had taken seroquel[ 150mg]. His psychiatrist refused to order a blood test telling me that I should see a therapist and stop worrying so I had his MD do one on my own. The CPK was at 3600. The seroquel was stopped and the CPK went down to 229 within a weeek after stopping the seroquel.Sseroquel had been added to 5mgs respirdol which my son has been taking for a year. Now one month later the CPK is still at 229. My son will see a neurologist 6/4/01. What tests should be done? How invasive are they? Should a specialist do them? How will we know if the elevation is due to heart, muscle or brain involvement? Is this NMS? How worried should I be? My son is 31 and diagnosed with schizophrenia. Psychologically he is doing very well. Thank You for responding.
Posted by stjames on May 20, 2001, at 19:45:44
In reply to Re: Elevated CPK - Question for CAm » mannetje, posted by Sunnely on May 19, 2001, at 22:40:32
Your son needs a new psychiatrist, the present one's unwillingness to do tests indicates he/she does not have your sons bets intrests in mind and is too quick to brush off your concerns.
Your son will have to be on an AP, that is a given based on his condition. You need to find someone who you can trust.
james
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.