Potassium chloride 0.15% (potassium 20mmol/1litre) / Magnesium chloride 0.2% (magnesium 10mmol/1litre) / Sodium chloride 0.9% infusion 1litre bags

BackgroundHypertension is a major risk factor for cardiovascular disease. Salt substitutes may reduce sodium intake while maintaining palatability, but comparative effects across formulations remain uncertain.MethodsWe conducted a systematic review and frequentist random-effects network meta-analysis of randomised controlled trials in adults comparing salt substitutes with regular salt, other substitutes or no intervention. Databases (PubMed, Embase, CENTRAL, CNKI, Wanfang), WHO-ICTRP and ClinicalTrials.gov were searched from inception to Oct 3, 2025 (PROSPERO CRD42023451859). We assessed the risk of bias using a modified Cochrane tool and conducted a random-effects network meta-analysis, with evidence certainty evaluated through the GRADE approach.ResultsWe included 34 randomised controlled trials involving 37,063 participants across 15 countries (17 from China, 17 from other countries; mean age 62.3 years). Our results indicate that moderate-potassium and low-sodium salt substitutes (25-40% KCl, 60-79% NaCl) probably reduce all-cause mortality, cardiovascular mortality, non-fatal cardiovascular events and systolic blood pressure (SBP) compared to regular salt, with reductions of 7-17 deaths per 1000 individuals and 4.39-4.64 mmHg for SBP, based on moderate to high certainty evidence. Mortality and cardiovascular benefits are predominantly driven by one large Chinese trial (SSaSS, n = 20,995); excluding this trial eliminated statistical significance for all-cause mortality. Among non-Chinese studies, none contributed mortality data. Substitutes with higher potassium or very low sodium showed similar blood pressure reductions but provided less certain evidence regarding mortality and events. No substitute increased adverse events or withdrawals, and acceptability was comparable to regular salt.ConclusionsSalt substitutes, particularly moderate-potassium and low-sodium formulations, represent a promising sodium reduction strategy. However, current evidence for mortality and cardiovascular event benefits is dominated by one large Chinese trial and has very limited generalisability beyond Chinese populations with high discretionary salt use. These products appear acceptable and safe in people without renal impairment, but clinicians should rule out kidney disease and hyperkalaemia risk before recommending them, and large trials in non-Chinese populations are needed.

Abstract licence: CC BY-NC-ND

BackgroundTemporomandibular disorders (TMDs) are a major cause of chronic orofacial pain, with myalgia of the masticatory muscles being central to symptom burden. Electrolyte modulation, particularly magnesium, may influence neuromuscular excitability and nociceptor sensitization, but no systematic review has synthesized the evidence for muscle pain syndromes or its relevance to TMD.ObjectivesTo evaluate the efficacy of electrolyte supplementation (magnesium, sodium, calcium, and potassium) in reducing muscle cramps and myalgia, and to explore the biological plausibility and potential extrapolation to TMD-related myofascial pain.MethodsThis systematic review followed PRISMA guidelines and was prospectively registered in PROSPERO (CRD420251120631). PubMed/MEDLINE, Embase, and Cochrane CENTRAL were searched from January 1995 to August 2025. Randomized or quasi-randomized trials of electrolyte supplementation for cramps or myalgia were eligible. Data extraction and risk-of-bias assessment (RoB 2 tool) were performed independently by 2 reviewers. Meta-analyses used random-effects models in R (v4.4.3) and Python (v3.11).ResultsThirteen trials were included. Magnesium was most frequently studied (10 RCTs). In pregnancy-associated cramps (4 trials, N≈364), magnesium significantly reduced cramp frequency compared with placebo (pooled RR 1.35, 95% CI: 1.05-1.74, P = .02). In nocturnal or persistent leg cramps in adults (4 trials, N≈396), no significant effect was found (MD -0.42 cramps/week, 95% CI: -1.15 to 0.31, P = .26). Intravenous magnesium showed no benefit in older adults, but a perioperative trial demonstrated reduced fasciculations and postoperative myalgia. Sodium-based solutions reduced cramp susceptibility in exercise and cirrhosis, while calcium and potassium lacked supportive evidence. Risk of bias was generally low to moderate.ConclusionMagnesium supplementation benefits pregnancy-related cramps but shows inconsistent effects in other populations. Sodium-based interventions are context-specific, and calcium and potassium remain unsupported. Magnesium is the most plausible candidate for translation to TMD myalgia, warranting targeted clinical trials.

Abstract licence: CC BY-NC-ND

Background: Dialysis patients have a very high burden of cardiovascular mortality, yet the contribution of specific serum electrolytes to sudden cardiac death (SCD) and cardiovascular death across haemodialysis (HD) and peritoneal dialysis (PD) remains uncertain. Methods: We conducted a PROSPERO-registered systematic review and meta-analysis (2010-2025) of cohort studies reporting adjusted hazard ratios (HRs) for the association between baseline or time-averaged serum electrolytes and cardiovascular mortality or SCD in adult maintenance HD and/or PD. Random-effects models with modality-specific and pooled analyses were applied. Results: Thirty-five cohorts (over 200,000 patients) met inclusion criteria. Across modalities, categorical analyses showed that high phosphate and low magnesium were consistently associated with approximately 2-fold higher cardiovascular mortality, while extreme potassium categories conferred similar excess risk, driven largely by PD. In HD, hypomagnesaemia and hyperphosphataemia were each associated with around 2-fold higher risk, and lower continuous sodium levels were linearly related to higher cardiovascular mortality. In PD, severe potassium abnormalities, hypomagnesaemia and high phosphate categories were strongly associated with cardiovascular death, and a lower Na/Cl ratio identified patients at particularly high risk. Heterogeneity was generally modest for categorical magnesium and phosphate, but substantial for some potassium and continuous-exposure models. Sensitivity analyses confirmed the robustness of key findings. Conclusions: Across HD and PD, abnormalities in phosphate, magnesium, potassium and sodium are strong and largely consistent markers of cardiovascular mortality, and likely SCD, with important modality-specific patterns. These data support intensified, modality-tailored management of electrolyte profiles as a central component of cardiovascular and SCD risk reduction in dialysis.

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Despite consistent evidence of the cardioprotective benefits of reduced-sodium salt, it remains an underutilised intervention. Understanding how reduced-sodium salt is perceived is required to scale-up its use. This review summarises end user and healthcare professional knowledge, attitudes, and behaviours about reduced-sodium salt. We systematically searched four databases (inception to February 2024) and identified studies reporting knowledge, attitudes and behaviours towards reduced-sodium salt. Twenty-nine studies from 11 countries were included, 18 of which were intervention studies involving reduced-sodium salt and 11 were descriptive studies examining perceptions among the general community and healthcare professionals. Among intervention studies, there was high overall acceptability but mixed findings on taste. Outcomes related to use or willingness to use were mostly positive especially following cost-subsidisation. Among descriptive studies, there was low awareness (ranging from 0-32%) and reported use (10-16%) of reduced-sodium salt among the general community. Barriers to use included low availability and higher costs compared to regular salt. Awareness was higher among healthcare professionals (71%). Overall, most studies found high acceptability and willingness to use following exposure to reduced-sodium salt, despite some detecting taste differences. Greater awareness coupled with strategies to improve availability and affordability are important to scale-up the use of reduced-sodium salt.

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Electrolyte disorders are pivotal determinants of morbidity and mortality in neurocritical care and exacerbated by acute brain injury, neuroendocrine dysfunction, and therapeutic interventions. This narrative review synthesized contemporary evidence on the pathophysiology, diagnosis, and management of hydroelectrolytic disturbances in neuroanesthesia and neurocritical populations. Dysnatremias (hyponatremia and hypernatremia) are prevalent with emerging data challenging historical correction paradigms: Rapid sodium normalization may reduce mortality without increasing complications. Distinct strategies are required for syndromes of inappropriate antidiuretic hormone secretion (fluid restriction, vaptans) vs cerebral salt wasting (volume resuscitation). Chloride dysregulation, driven by cation-chloride cotransporter imbalances, exacerbates cytotoxic edema and seizures, warranting trials of bumetanide and balanced crystalloids. Hypokalemia, prevalent in traumatic brain injury, demands proactive surveillance to prevent arrhythmias while hyperkalemia management prioritizes membrane stabilization and renal clearance. Hypocalcemia correlates with adverse outcomes in subarachnoid hemorrhage, necessitating timely replacement. Magnesium disorders lack consistent prognostic associations in neurocritical cohorts, contrasting with general critical care. Current evidence underscores the need for individualized, pathophysiology-driven correction, integrating endocrine and neurological principles. Innovations such as point-of-care testing and targeted therapies (e.g., acetate-buffered hypertonic saline) show promise, yet reliance on observational data and preclinical models highlights the urgency for randomized controlled trials. This review advocated for protocolized monitoring, dynamic assessments, and research to define optimal correction thresholds and validate emerging interventions in this high-risk population.

Abstract licence: CC BY-NC