Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) are characterised by pulmonary oedema results from increased vascular permeability. The resolution of pulmonary oedema and ALI depends upon intact Alveolar Fluid Clearance (AFC). Sodium transport Across Alveolar Epithelial Cells (AECs) leads to osmotic alveolar water transport and plays a dominant role in AFC. Sodium transports via apical sodium channels, mainly the Epithelial Sodium Channel (ENaC) and basolateral Sodium-Potassium Adenosine Triphosphatase (Na + , K +-ATPase) in the AEC membrane. In ALI/ARDS, the imbalance of oxygen, Reactive Nitrogen and Oxygen Species (RNS and ROS, respectively), and Tumour Necrosis Factor-α (TNF-α) lead to a decrease in AFC, due in part to the down regulation of ENaC and Na + , K +-ATPase in the alveolar epithelium. In ALI, hypoxia inhibits ENaC and Na + , K +-ATPase activity through different mechanisms. The definite mechanism of ENaC and Na + , K +-ATPase activity regulation by RNS and ROS is unclear. TNF-α, and its lectin-like domain (designated TIP) differentially impact sodium transport across the alveolar epithelium. In this review, we will discuss the regulatory mechanisms of alveolar sodium transport and AFC for the development of effective therapeutic strategies for ALI/ARDS patients.