Severe hypovolemia must be treated rapidly with intravenous (IV) boluses of isotonic saline Once circulating volume is adequate, further treatment of hypovolemia will depend on the serum sodium Overly rapid correction of hypo- or hypernatremia can lead to serious central nervous system (CNS) complications Treatment of severe hyperkalemia is aimed at stabilizing the myocardium to prevent arrhythmias and enhancing movement of potassium into the intracellular space Metabolic acidosis is primarily treated by attempting to correct the underlying cause Acute kidney injury (AKI) may lead to severe fluid and electrolyte disturbances that require emergent intervention regardless of the underlying etiology The management of many causes of AKI is supportive in nature Nephrotic syndrome is often steroid responsive in children Chronic kidney disease (CKD) may go unrecognized prior to presentation to the ED RELATED CHAPTERS