Fluid and electrolyte management in the very low birth weight infant is critical to survival. The amount of fluid present in the plasma, interstitial fluid, and cellular fluid changes throughout the fetal and neonatal period, presenting a challenging situation. One of the many factors influencing fluid requirements is the insensible water loss by mechanisms such as evaporation. Low birth weight infants are especially susceptible to this due to their large body surface area and immature skin, often resulting in hypernatremia and the complications associated with it. However, some infants may experience hyperkalemia, hyperglycemia, and/or hyponatremia, resulting in various other complications. Careful monitoring is essential in deciding how to manage these infants. This article aims to discuss the management of fluid and electrolytes in very low birth weight infants and address ways to decrease the morbidity and mortality associated with the imbalances in fluid and electrolytes seen in this population.