The body regulates the fluid concentration within the body, along with the solutes, within a narrow range by the action of multiple receptors, hormones, and organs. Sodium is the principal extracellular cation, and thus it affects the flow of water from the extracellular compartment into the intracellular compartment. Sodium imbalances can be life-threatening as they may cause cerebral edema leading to brain herniation or brain shrinkage leading to cerebral vein rupture in the cases of hyponatremia and hypernatremia, respectively. We aimed to review the literature looking into sodium imbalances, along with the acute phase management. PubMed database was used for articles selection, from where papers were obtained and reviewed. The regimen for correcting sodium imbalances depends on multiple factors, including the severity of the symptoms, the concentration of serum sodium, and the patients’ risk factors. This is put to avoid overcorrection and its complications. In the case of hyponatremia, overcorrection may lead to osmotic demyelination syndrome. As for hypernatremia, over-correction may lead to cerebral herniation. It is imperative to know the rate for correction and the etiologies for sodium imbalances as they are the cornerstone of therapy in the acute phase.