Perturbation in the balance of electrolytes can cause both central and peripheral neurological symptoms. Hyponatremia can be the most challenging electrolyte abnormality to correctly diagnose. Regardless of etiology, neurological manifestations are more likely to be present in acute rather than chronic hyponatremia because the rapid decrease in extracellular sodium precipitates intracellular fluid shifts and cellular edema. Calcium stabilizes electrically excitable cell membranes in nerve and muscle tissue and its derangements can have significant neurological sequellae. Like calcium, magnesium has a stabilizing effect on electrically excitable cell membranes. Phosphate homeostasis is closely tied to that of calcium. Hyperphosphatemia can result in symptomatic hypocalcemia and ectopic calcification but it does not generally have neurological manifestations. Phosphate can also be depleted in malnourished patients. Prompt diagnosis and correct management are important to prevent neurological and systemic complications of electrolyte derangements.