The introduction of the squid giant axon preparation to studies on Ca homeostasis has proven very useful in laying the foundations in the study of Ca regulation. In particular the Na/Ca exchange mechanism has been characterized in terms of its regulatory processes using the well define technique of intracellular dialysis and membrane potential control. The Na/Ca exchange countertransport system plays a critical role in physiological processes including cardiac contractility and photoreception. It has also been implicate in the etiology of essential hypertension, cardiac arrhythmias and cell death. The ability of the Na/Ca exchanger to regulate the intracellular ionized Ca concentration ([Ca2+i]) under physiological conditions, is determined by the direction (net Ca efflux or Ca influx), and magnitude of transport. The direction of Ca transport is decided by the chemical gradient of sodium and calcium. The magnitude of the exchange is regulated by kinetic factors. This kinetic factors are critical since they decide whether the exchanger will mediate a net Ca movement under certain conditions. Recently, a large effort has been put together to characterize the secondary modulation of the Na/Ca exchanger. In particular modulation by MgATP and intracellular Ca2+. In nerve cells we have discover that MgATP regulates the exchanger through as phosphorylation-dephosphorylation processes most probably relate to the action of a kinase-phosphatase system. The other important ligand that regulates the exchange activity is the level of [Ca2+i]. We have found the presence of a regulatory site in the cytoplasmic face of the exchanger different from the transport site and probably responsible for turning the carrier "on" or "off". In this article we will depict some of the processes involved in the metabolic and ionic regulation of the Na/Ca exchanger.