Metabolic & Endocrine

Hypo/Hyper conditions

Hyperglycemia

High blood glucose (>180–250 mg/dL) from too little insulin, infection, stress, or overeating.

PT/First Aid:

• Do NOT give sugar.

• Avoid exercise if glucose >250 mg/dL.

Hyperglycemia S&S

• gradual onset

• Thirst, frequent urination

• Drowsy

• Deep, labored breathing

• Fruity breath

Hypoglycemia

• Low blood sugar, usually <70 mg/dL.

• Happens when glucose drops below what the body/brain needs.

PT/First Aid:

• Give sugar (juice, glucose tabs).

• If unresponsive → call for help, no oral sugar.

• Hungry Hungry hippo

Hypoglycemia S&S

• Sudden onset

• Pale, moist skin

• Hunger & irritability (Hangry)

• Weakness, blurred vision

• Normal Breathing

• No vomiting 

Hashimoto’s Disease (Hypothyroidism)

Definition & Causes:
Autoimmune destruction of the thyroid → low thyroid hormone (Hypothyroidism)

PT Note:
Low energy → pace activities, allow rest breaks.

Graves’ Disease (Hyperthyroidism)

Definition & Causes:
Autoimmune overstimulation of thyroid → excess thyroid hormone (hyperthyroidism)

PT Note:
Avoid overheating and high-intensity exercise; monitor vitals.

Addison’s Disease 

Definition & Causes:
Adrenal glands fail to produce enough cortisol (and aldosterone); often autoimmune or adrenal damage (Hypercortisolism)

PT Note:
Avoid stress overload; risk of Addisonian crisis (severe low BP).

Addison’s Disease S&S

• Extreme Fatigue

• Muscle weakness

• Weight loss

• Low blood pressure

• Salt Cravings

• Dizziness, fainting

• Hyperpigmentation

• Nausea, vomiting

Cushing’s Syndrome

Definition & Causes:
Excess cortisol from tumor, long-term steroid use, or pituitary/adrenal overproduction (Hypercortisolism)

PT Note:
Use gentle handling; monitor BP and fall risk.

Cushing’s Disease S&S

• Central obesity, thin arms/legs

• Muscle weakness, easy bruising

• High blood pressure, high blood sugar

• Kyphosis

• Fragile skin, osteoporosis

• Thinning hair

• “Moon face,” “buffalo hump”

Diabetes Insipidus

Definition & Causes:
A disorder where the body doesn’t produce enough antidiuretic hormone (ADH) or the kidneys don’t respond to it, leading to excess water loss

PT Note:
Monitor for dehydration and fatigue during activity; ensure access to fluids.

Diabetes Insipidus S&S

• Extreme thirst (polydipsia)

• Excessive urination (polyuria — very dilute urine)

• Dehydration

• Fatigue, weakness

• Dry mouth

• Possible low blood pressure or dizziness

Calcium

Controls muscles, nerves, and bones (health of each)

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• hypocalcemia: muscles are twitchy and overactive

• hypercalcemia: muscles are weak, decreased bone density, kidney stone formation

Parathyroid Hormone (PTH)

Increases blood calcium levels by:

• Releasing calcium from bones

• Increasing calcium absorption from the gut (via vitamin D)

• Reducing calcium loss in urine

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• Hypoparathyroidism → Low calcium → muscle spasm

• Hyperparathyroidism → High Calcium → bone loss, kidney stone formation

Thyroid Hormones

• Regulate metabolism (how fast cells use energy)

• Affect heart rate, temperature, and energy levels

• Support growth and brain development

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• Hashimoto’s (hypo): slow metabolism → fatigue, weight gain, cold intolerance 

• Graves’ (hyper): fast metabolism → heat intolerance, weight loss, tachycardia 

Insulin (from pancreas)

lower blood glucose by helping absorb sugar

Glucagon (from pancreas)

raises blood glucose by releasing sugar from the liver

Cortisol

• Maintains blood pressure and blood sugar

• Helps the body respond to stress

• Controls inflammation and immune response

• Regulates metabolism of fats, proteins, and carbs

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• Addison’s (hypo): fatigue, low BP, weight loss, hyperpigmentation

• Cushing’s: muscle weakness, central obesity, high BP, high glucose 

Antidiuretic Hormone (ADH)

• Controls water balance by signaling the kidneys to reabsorb water

• Maintains blood pressure and hydration

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• Low (Diabetes Insipidus): → excessive urination, dehydration, thirst

• High: → water retention, low sodium

Sodium

controls fluid balance and BP

Potassium

controls heart rhythm and muscle contraction

Gigantism

overproduction of growth hormone before puberty 

Acromegaly

abnormal growth in the body d/t overproduction of growth hormone after puberty

Metabolic Acidosis

Definition: too much acid in the system

Cause:

• Renal failure (acid retention)

• diabetic/alcoholic ketoacidosis

• Lactic acidosis

• Toxins

• Base deficits (diarrhea)

Metabolic Acidosis S&S

• Compensatory hyperventilation

• mm weakness/twitching

• Nausea, vomiting

• Diarrhea

• Headache

• Arrhythmias

Metabolic Alkalosis 

Too basic

Causes:

• Hypokalemia (diuretics)

• Vomiting

• Nasogastric suctioning

• Excessive HCO3 intake (Tums)

• Excessive HC03 resorption (Cushing disease/hypercortisolism)

Metabolic Alkalosis S&S

• Compensatory hyperventilation

• mm weakness/twitching

• Nausea, vomiting

• Diarrhea

• Restlessness 

• Paresthesia, seizures, coma

Graves’ Disease (hyperthyroidism) S&S

• Weight loss despite normal appetite

• Heat intolerance

• Tremor, anxiety, restlessness

• Increased HR, palpitations, RR

• Bulging eyes (exophthalmos)

• warm, flushed skin

Hashimoto’s Disease (Hypothyroidism) S&S

• Weight gain

• Anxiety, slow mentation

• Skin pallor, cold skin, cold intolerance

• Cold intolerance

• Fatigue

• Joint stiffness

• Hair loss, dry skin

• Bradycardia/ slow reflexes

• Constipation

Diabetes Type I

• no insulin produced

• “childhood” diabetes

Diabetes Type II

• defective insulin absorption

• metabolic syndrome

• more common in adults (obesity)

Fasting blood glucose levels

• Normal: < 100 mg/dL

• Prediabetes: 100 -125 mg/dL

• Diabetes: >125 mg/dL

blood glucose levels > 300mg/dL

• do NOT exercise → chance it’ll result in a coma

• If they are showing symptoms → call 911!

• If they are not showing symptoms, don’t do exercise and tell them to go to the Dr!

Target blood glucose

70 - 100 mg/dL

Diabetes & Exercise

• Avoid exercise within 1 hour of insulin injection

• Exercise at the same time each day

• Keep a regular meal schedule

• Give 15g carbs before activity

  • for long activity - add 10-15g every 30min

Lipid Panel:

Normal

• Triglycerides: <150 mg/dL

• HDL:

  • >40 mg/dL Males

  • >50 mg/dL Females

• LDL: <100 mg/dL

• Total Cholesterol: <200 mg/dL

Lipid Panel:

High

• Triglycerides: >200 mg/dL

• LDL: >160 mg/dL

• Total Cholesterol: >240 mg/dL

Respiratory Acidosis

• Increased CO2 / retention of CO2

• Causes:

  • Acute respiratory failure

  • COPD

  • GBS

  • myasthenia gravis

  • drugs, stroke

  • Burns

  • inadequate mechanical ventilation

Respiratory Acidosis S&S

• Decreased ventilation

• Confusion

• Sleepiness

• Diaphoresis

• Cyanosis

• restlessness/decreased DTR’s

Respiratory Alkalosis

• Decreased CO2

• Causes:

  • Hypoxemia (PE, higher altitude)

  • Impaired lung expansion

  • CHF

  • Anxiety, stress

  • Severe pain

  • Mechanical overventilation 

Respiratory Alkalosis S&S

• Hyperventilation 

• Lightheadedness

• Dizziness

• N/T face, fingers, toes

• Syncope

• Muscle cramps/spasms