When are salt tablets recommended for replenishing lost salts and fluids?

Salt Tablets for Replenishing Lost Salts and Fluids

Salt tablets are recommended primarily for athletes during prolonged vigorous exercise (>4 hours) in hot environments when excessive sweating occurs, and for specific medical conditions including cystic fibrosis, short bowel syndrome, and severe dehydration with sodium depletion. 1

Athletic Performance and Exercise

When Salt Tablets Are Indicated

• Athletes training or competing in hot environments with high sweat rates (>1.5-2.5 L/hour) require sodium supplementation beyond normal dietary intake 1
• Salt tablets or sodium chloride capsules are specifically recommended during stress situations with excessive sweating, including fever, exercise/sports, and hot weather 1
• Sodium supplementation might be required during intense prolonged exercise in the heat to minimize body water mass losses and reduce physiological strain 1

Practical Implementation for Athletes

• Athletes have higher daily sodium requirements (3500-7000 mg) than the general population when training in hot weather 1, 2
• Multiple methods exist for sodium replacement: increased table salt on foods, salty snacks, adding salt to sports drinks, or salt tablets 3
• The preferred method of rehydration is through consumption of fluids with salty foods rather than isolated salt tablets 1
• For rapid rehydration after exercise, replace 100-150% of body mass losses with fluids containing electrolytes 1

Important Caveats for Athletes

• Avoid salt tablets with pre-exercise saline solutions exceeding 164 mmol/L Na+ (approximately 0.9% saline), as excessive sodium counteracts beneficial effects on heat dissipation and performance 4
• Overdrinking plain water during prolonged exercise (>4 hours) without sodium replacement can cause exercise-associated hyponatremia 1
• Drinking to thirst is the safest general strategy, but athletes at risk for significant sodium losses may benefit from specific supplementation plans 1

Medical Conditions Requiring Salt Tablets

Cystic Fibrosis

• Breastfed infants (0-6 months) with CF require 1-2 mmol/kg/day sodium supplementation, given in small portions throughout the day diluted in water or fruit juice 1
• Infants with increased fluid losses (hot temperatures, vomiting, fever, diarrhea, tachypnea, or ostomies) may require up to 4 mmol/kg/day 1
• Older children through adults with CF should use sodium chloride capsules or vials during stress situations with excessive sweating 1

Short Bowel Syndrome and Chronic Intestinal Failure

• Patients with high-output jejunostomy who have borderline dehydration or sodium depletion should use isotonic high-sodium oral rehydration solution (120 mmol/L sodium) to replace stoma losses 1
• SBS patients should use salt liberally on meals and snacks, with some tolerating sodium chloride capsules up to 7 g/24 hours 1
• This is particularly critical for patients with reduced jejunum length ending in a stoma, who may secrete more sodium and fluid than they consume orally 1

Acute Dehydration and Syncope

• In selected patients with syncope due to dehydration, increased salt and fluid intake is reasonable, provided as sodium tablets or sodium dissolved in beverages 1
• Sodium supplementation improves plasma volume and orthostatic tolerance in dehydrated patients 1
• This treatment is contraindicated in patients with cardiac dysfunction, heart failure, uncontrolled hypertension, or chronic kidney disease 1

When Salt Tablets Are NOT Recommended

• For acute diarrheal illness, oral rehydration solutions (not salt tablets alone) are the standard of care 1, 5, 6
• Most recreational athletes and individuals with normal dietary intake do not require salt tablets 3
• Salt tablets should not be used for routine daily hydration in healthy individuals 1
• Female athletes typically have lower sweat rates than males and may not require aggressive sodium supplementation unless participating in ultra-endurance events 1

Monitoring and Safety

• Athletes should monitor pre- and post-exercise body weight to guide fluid and sodium replacement decisions 3
• Daily morning body mass and urine specific gravity (target <1.020) can assess hydration status during multi-day competitions 1
• Excessive sodium intake can increase osmolality, elevate core temperature, and negate performance benefits 4