OBJECTIVE: This study aims to determine the prevalence of electrolyte disturbances in children hospitalized in the pediatric intensive care unit (PICU) of Rajendra Institute of Medical Sciences (RIMS), a tertiary care center in Ranchi, India, and to evaluate related factors like pneumonia, heart disease, meningitis/encephalitis, and others. METHODS: Serum electrolyte levels (sodium, potassium, calcium, magnesium) were obtained from 110 patients admitted to the PICU at RIMS. Statistical analyses were conducted to identify the prevalence and association of disturbances with specific diseases. RESULTS: Sodium disturbances was most common (32 cases, 29%), with 28 (25.45%) patients exhibiting hyponatremia and four exhibiting hypernatremia (3.63%). Hypokalemia (10 cases, 9.09%) was associated predominantly with central nervous system (CNS) disorders. Hypocalcemia (26 cases, 23.63%) was most frequently linked to respiratory disorders. Hypomagnesemia cases (18, 16.36%) were also prevalent. CONCLUSION: Electrolyte disturbances are common in critically ill pediatric patients and are associated with various systemic disorders, emphasizing the need for regular monitoring in the PICU.