How do you counsel patients on use of creatine monohydrate supplementation during a hospitalization for acute rhabdomyolysis from intense physical training?

I was a primary care doctor for the military for a few years. We regularly saw patients presenting with rhabdomyolysis from intense physical training. A standard question for all that present with this is whether supplements are being used. While there isn't a direct linkage to say that the use of creatine monohydrate supplementation causes renal dysfunction, when patients present with rhabdomyolysis, all potential triggers should be stopped.

Creatine should be held until complete recovery of rhabdomyolysis with normalized CK level and renal function. For anyone with additional risk factors such as hypertension, diabetes, or CKD, creatine should be avoided.

All this being said, after one presentation with rhabdomyolysis, I will typically ad...

Creatine monohydrate converts to creatinine and increases the serum creatinine level. But kidney function and true GFR remain intact. Creatinine is not toxic.

There is no nephrotoxicity of creatine monohydrate. It should be avoided in patients with impaired renal function due to a lack of safety data in such a population. It should be held until the renal function improves.

Creatine monohydrate doesn't cause rhabdomyolysis or elevation of CK (Creatine Kinase), thus no counseling is needed.

I would advise stopping the supplements at least while resolving the crisis.