Potassium chloride 0.15% (potassium 20mmol/1litre) / Magnesium sulfate 0.5% (magnesium 20mmol/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

Intravenous magnesium is commonly used in clinical practice for treating Torsade de Pointes (TdP), although supporting evidence remains limited. This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension guidelines. Four online databases were searched for relevant studies published as of November 27, 2024, but only 4 observational studies met the inclusion criteria. TdP resolved in a substantial proportion of patients treated with intravenous magnesium (78.3% [N=36/46]), although most studies lacked a control group. No serious adverse events related to magnesium were reported (0% [N=0/46]). Despite several limitations that preclude firm conclusions, intravenous magnesium appears to be a relatively safe and effective treatment for TdP. However, TdP progressed to ventricular fibrillation (VF) in 21.7% (N=10/46) of patients, underscoring the need for readiness to perform immediate electrical defibrillation during treatment. Further high-quality studies are warranted to validate these findings.

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Hypertension represents a major risk factor for cardiovascular diseases. As a diet high in sodium chloride is associated with hypertension, so-called "blood pressure salts" are attracting increasing scientific interest. These are characterized by a partial replacement of sodium chloride by other salts, mainly potassium and magnesium compounds. The aim of this review is to evaluate the bioavailability of potassium and magnesium salts as dietary supplements and to identify potential sodium chloride substitutes. A literature search was conducted in the PubMed database using the PICO scheme. Randomized controlled trials in healthy adults investigating the bioavailability of defined potassium/magnesium salts were included. Potassium chloride and potassium citrate showed good bioavailability irrespective of the route of administration and dose. Magnesium citrate and magnesium chloride showed good bioavailability while magnesium oxide was poorly bioavailable. This may be partly due to its poor solubility in water. The results indicate that potassium chloride and potassium citrate as well as magnesium citrate and chloride are suitable for the use as salt substitutes and for increasing potassium and magnesium intake in addition to reducing sodium. Due to its poor water solubility and consequently low bioavailability magnesium oxide is less suitable.

Abstract licence: CC BY