Blood leukocytes and blood glucose are often significantly elevated in severe cases of HFMD, and in some cases ALT, AST and cK-MB are elevated. Arterial blood gas analysis may show acidosis and hypoxemia when circulatory respiration is affected. The cerebrospinal fluid is clear, with elevated pressure, elevated leukocytes, normal or mildly elevated proteins, and normal sugars and chlorides. x-ray chest radiographs may show increased texture in both lungs, with grid-like, dot-like, or large patchy shadows, some cases being unilateral. Abnormal changes can be seen on cranial MRI, with brainstem and spinal cord gray matter damage predominant.