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 Also called creatine phosphokinase (CPK).

 The reference range for the horse is 108–430 U/l.

 CK is a specific indicator of muscle damage.It is a “leakage” enzyme released secondary to myocyte damage or death.

 Serum concentrations increase quickly following myocyte damage.In contrast to aspartate aminotransferase (AST) concentrations which increase more slowly and persist for longer (see below).

 CK has a short half‐life (hours); thus, serum concentrations decrease quickly after an episode.

 Urine will be positive for blood on test strips if myoglobin is present.Myoglobin and free hemoglobin have peroxidase‐like activity, which results in oxygen liberation from organic peroxide in the reagent strip, causing a color change in the strip.The urine may be “coffee” colored.

Mild increases in CK (1000–5000 U/l) may result from:

 Recumbency, trailer ride, recent exercise, or intramuscular injections.

 Consider a diagnosis of mild exertional rhabdomyolysis (ER) and/or polysaccharide storage myopathy (PSSM) if the above conditions are not applicable.

Moderate (~5000 U/l) to severe increases in CK (>10 000 U/l):

 Severe cases of ER may have associated CK values >100 000 U/l.

 These high values may be associated with a traumatic event, but may occur following general anesthesia.

Note: Because myoglobin may cause renal tubular damage, treatment may be indicated.