Creatine hydrate

A. Creatinine. A mixture of 900 g. of commercial creatine hydrate (Note 1) with 550 cc. of concentrated hydrochloric acid (sp. gr. 1.19) and 150 cc. of water is warmed in a 3-I. flask on the steam bath for twenty-four hours. The hot solution is filtered and chilled to 0-50 in an ice bath, and to it is added 1000 cc. of 28 per cent aqueous ammonia (sp. gr. 0.90). The flask is immersed in an ice-salt bath and the mixture is stirred vigorously until the temperature falls to o°, when the crystalline creatinine is filtered off, washed with ice-cold 28 per cent aqueous ammonia (Note 2) until the filtrate is free of chlorides, and finally with ice-cold methyl alcohol the product (Note 3) is then dried to constant weight at 40-50°. The yield (Note 4) is 545—555 g. (80-81 per cent of the theoretical amount). 

B. Creatinine Zinc Chloride. An intimate mixture of 400 g. of commercial creatine hydrate and 400 g. of fused zinc chloride is heated in a porcelain dish over a small flame. The mixture melts to a viscous liquid which soon solidifies. The flame is removed when the mixture can no longer be stirred. The mass, when cold, is broken up, and stirred with 500 cc. of cold water until the lumps are softened the crude creatinine zinc chloride is filtered off with suction, by the use of a hardened filter paper,... 

A newer development is the use of urea in a mixture, called Carbatine , containing urea and creatine (Moss, 1992, p. 372). For the record, creatine is (a-methylguanido) acetic acid, with the chemical or molecular formula NH2C( NH)N(CH3)CH2C02H. It is an alkaloid or amino acid found in the muscles of vertebrates. The active nitrogen content is apparently greater compared to that of urea alone. Moss supphes the names of doctors who use urea therapy as well as suppliers for the creatine hydrate and Carbatine. 

Amino-6-methylheptane Bromelain concentrate Creatine hydrate... 

A 64-year-old African-American man developed worsening renal insufficiency, raised creatine kinase activity, diffuse muscle pain, and severe muscle weakness. He had been taking simvastatin for about 6 months and clarithromycin for sinusitis for about 3 weeks. He was treated aggressively with intravenous hydration, sodium bicarbonate, and hemodialysis. A muscle biopsy showed necrotizing myopathy secondary to a toxin. He continued to receive intermittent hemodialysis until he died from infectious complications 3 months after admission. 

On June 6, this patient developed severe loin pain after he participated in two 150-m sprints at a town athletics meeting. After 5 days, he was referred to the outpatient clinic of our department. His serum creatinine and uric acid levels and FEUA, were 2.9mg/dl, 2.1 mg/dl, and 49.7%, respectively. His creatine phosphokinase (CPK) level was normal. When his serum creatinine level decreased to 1.58 mg/dl, a contrast medium was administered. A delayed computed tomography (CT) scan after 24 and 48 h confirmed patchy wedge-shaped contrast enhancement (Fig. 58). Under a diagnosis of ALPE, his body water balance (hydration) was controlled. In this patient, recovery was achieved 4 weeks after onset, and his serum creatinine and uric acid levels were then 1.0 mg/dl and 0.6 mg/dl, respectively. Furthermore, load tests with a uric acid reabsorption inhibitor (benzbromarone) and a uric acid excretion inhibitor (pyrazinamide) suggested presecretory reabsorption defect-related renal hypouricemia. A kidney biopsy 16 days after onset confirmed the recovery from acute tubular necrosis. 

Plainly creatinine is the hydrate of creatine or, vice versa, creatine is the anhydride of creatinine. Both of these compounds are found in urine associated with urea as metabolic products of proteins. 

An 83-year-old man who had been taking multiple medications including simvastatin 40 mg daily for 2 years was given fluconazole 400 mg daily as part of a prophylactic regimen against chemotherapy-induced neutropenic sepsis. After one week he developed generalised muscle weakness and was found to have brown urine and an elevated serum creatine kinase. His medication was stopped, and he was treated with hydration and diuretics, after which his symptoms resolved. ... 

Musculoskeletal An autistic child developed rhabdomyolysis after taking only two doses of olanzapine [109 ]. The initial creatine kinase activity was 30690IU/1 (reference range 5-130 IU/1) rhabdomyolysis resolved with hydration and alkalinization over 7 days. 

Musculoskeletal Rhabdomyolysis was reported in a male patient receiving concomitant RBV, pegylated interferon and daptomycin [100 ]. Proximal myalgia and weakness developed in the patient who was receiving longterm treatment for chronic hepatitis C. There was clinical improvement and reduction in creatine phosphokinase gradually over 10 days with hydration after all three drugs were stopped. 

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