Creatine kinase (CK) is an enzyme found primarily in the brain, skeletal muscles, and heart. Conditions that cause damage to any of these three areas produce an elevated level of CK. For this reason, CK tests are often run to detect muscle damage, especially if someone is taking a drug such as a statin, using cocaine, or has been exposed to a toxin. If you’re experiencing chest pain or weakness your doctor may order a CK test to determine if you’ve had a heart attack. It is also common for doctors to use this test to evaluate the extent of sports injuries. Creatine kinase levels reflect the amount of muscle in the body, and as such men typically have higher levels than women. Finally, a CK test may be used to diagnose rhabdomyolysis, a condition characterized by the rapid breakdown of muscle tissue. It is worth noting that a normal level of CK does not necessarily mean that there is no muscle damage. It could mean that the damage occurred long enough ago for levels to return to normal. Frequently, a succession of CK tests are run as changes in CK levels due to muscle damage can take hours to present.
Normal Ranges:
Normal CK levels change drastically depending on factors such as age, gender, and activity level. Generally, 24-204 U/L is considered normal.
Creatine Kinase and liver enzymes (ALT and AST):
- A normal CK level with elevated ALT and AST enzymes would sway a doctor toward thinking there’s a liver problem;
- A high CK with high ALT and AST levels suggests that something’s going on in the muscle.
Doing additional enzyme tests after a general screen can help a doctor decide whether the high ALT and AST are more likely the result of liver or muscle damage.
Of course, there could be a problem in both liver and muscle. Some metabolic muscle disorders, such as acid maltase deficiency and debrancher enzyme deficiency, affect both tissues. And two diseases can occur in the same person.
Most of the time, elevated ALT and AST levels in people with degenerating muscles do not mean much, other than that these enzymes, along with CK, are leaking out of the muscles. (The high levels of enzymes do no harm in and of themselves.) But sometimes, depending on results of other tests and the person’s history, they can mean there’s trouble in the liver or even in another organ.
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Having a high level of creatine kinase (CK), or a rise in levels in subsequent CK tests, generally indicates that you have experienced some recent muscle damage.
A CK test cannot indicate which muscle(s) was damaged or the cause of the damage.
Healthcare providers often have you get multiple CK tests to check the progress of your levels. If you have multiple test results that peak and then begin to drop, it usually means your muscle damage has diminished. If your CK levels increase or stay at a persistently high level, it may indicate that you have ongoing muscle damage or muscle degeneration.
If your results show you have higher-than-normal levels of CK, your provider may order tests to check the levels of specific CK enzymes in order to determine the type of muscles affected, including:
- CK-MM enzymes (skeletal muscles cells): High levels of CK-MM may mean you have a muscle injury or disease, such as muscular dystrophy or rhabdomyolysis.
- CK-MB enzymes (heart muscle cells): High levels of CK-MB may mean you have an inflammation in your heart muscle or are having or recently had a heart attack.
- CK-BB enzymes (brain tissue cells): High levels of CK-MB may mean you have had a stroke or brain injury.
Other causes of increased creatine kinase (CK) levels:
Certain conditions and injuries that are not directly related to your muscles can cause elevated CK levels, including:
- Hormonal (endocrine) disorders, such as thyroid disease, Addison’s disease or Cushing’s syndrome.
- Prolonged surgeries.
- Seizures.
- Infections (viral, bacterial, fungal or parasitic).
- Connective tissue disorders, such as lupus and rheumatoid arthritis.
- Celiac disease.
- Kidney (renal) failure.
- High fever accompanied by shivering.
- A blood clot.
- Any drug or toxin that interferes with muscle energy production or increases energy requirements.
- Shot injections.
Additional notes: If your creatine kinase (CK) test results reveal that you have high levels of CK, it does not't necessarily mean that you have a medical condition. Many other factors, such as exercise, certain medications and shot injections, can temporarily increase your CK levels. There could have also been an error in the processing of the test. When interpreting your results, your healthcare provider will consider several factors, including your current medications, lifestyle and symptoms. They will let you know if you need further testing.
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A low CK level could be the result of alcoholic liver disease or rheumatoid arthritis. As CK levels are a reflection of total muscle mass, people who have been confined to bed rest for extended periods of time will display abnormally low CK levels. Women generally have lower CK levels than men, because they typically have less muscle mass. Additionally, a pregnant woman will display lower CK levels than a non-pregnant woman.
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