Does Creatine Supplementation Increase the Risk

Journal represents the most serious published re-port to date of an adverse effect in a person taking oral creatine supplements. In light of its severity, it is prudent to speculate on the likelihood that this man's creatine consumption contributed to his rhabdomyolysis. Rhabdomyolysis results from a breakdown of the muscle cell wall, which leads to cell necrosis. It is thought to be the result of a plasma membrane defect or a disturbance in the sodium-potassium pump that allows an influx of calcium into the cell, which triggers a cascade of events leading to cell necrosis.2 Robinson speculates that intracellular water retention led to increased skeletal muscle compartment pressures, which placed the patient at risk for cellular wall breakdown. Such a hypothesis is simplistic yet worthy of consideration. It is accepted that oral creatine sup-plementation results in a rapid weight gain, easily noted within 24 hours.3,4 Clearly, 24 hours is not enough to induce skeletal muscle hypertrophy; the gain is the result of intracellular and extracellular fluid retention. Although no studies have evaluated creatine supplementation and its effect on muscle compartment pressures, anecdotal evidence of ath-letes feeling "tight " or "cramped " abounds. Muscle cramping remains one of the most common side effects reported by those taking creatine.5,6 Risk factors for rhabdomyolysis include dehy-dration, alcoholism, illicit drug use, trauma, stren-uous exercise, hypophosphatemia, and a hyperos-molal state.2,7,8 Robinson's patient had exercised the day before Robinson saw him, though his fluid and electrolyte status were not known. It has been hypothesized that creatine supplementation in-creases the risk of dehydration from intravascular volume depletion. Even creatine manufacturer