Figure 1. The patient’s serum creatine kinase and liver enzymes level over the course of her hospitalization. (A: Creatine kinase (CK). B: Aspartate aminotransferase (AST) and alanine aminotransferase (ALT). (A) Serum creatine kinase level increased from 29 000 U/L on Day 1 to 71 000 U/L while the patient was on maintenance fluids. In the following days, small boluses of normal saline were administered in addition to the maintenance fluid, and the serum creatine kinase started to decrease. (B) Liver enzyme levels started to increase the first day and then decreased after small boluses of normal saline were added. The levels follow the same pattern as those for creatine kinase. Also notice that the AST level is four times the ALT level during the hospital course.