Introduction: In the Emergency Department (ED), increasing time pressures and acuity require physicians to have access to quick and reliable data to guide patient care decisions. Blood gases (BGs) allow quick access to key information, and are used frequently in the ED. Our objective was to review the literature on reliability and accuracy of electrolyte measurements obtained from BGs in high acuity settings. Methods: A comprehensive literature review was conducted in September of 2015. The search strategy, done in conjunction with a medical librarian, identified studies that assessed the accuracy of BGs when compared to traditional laboratory serum measurements. Prior to the review we determined sodium and potassium would be the area of focus. Eligibility parameters for the studies included samples from acute care areas - the ED and ICU - and a comparison of BG and serum values taken simultaneously from the patient. Results: Our review included 12 studies, 9 in adult and 3 in pediatrics. There were approximately 1,135 patients included, consisting of 851 adult and 284 pediatric cases. The results were mixed; 9 studies agreed that sodium and potassium readings from BGs were accurate enough to guide acute care decisions, 5 did not. Furthermore, important questions were raised regarding the varying accuracy of BGs depending on what physiological level the electrolytes were at during the time of collection, i.e. at critical vs non-critical levels. Conclusion: This is the first literature review to examine the existing evidence on the accuracy of BGs in acute care environments. Given the variability in the results, a larger study needs to be done to determine the validity and reliability of blood gases for electrolytes in acute care settings. Only by ensuring the accuracy of data collected via point-of-care BGs can the most informed decisions be made surrounding patient care in acute care settings.