Endocrine, Metabolic, and Urinary System Pathologies

Diabetes Mellitus

Diabetes is a disorder of insulin regulation.

• Type I: Characterized by insulin deficiency (the pancreas produces too little).
• Type II: Characterized by insulin resistance (the body cannot use insulin properly).

Clinicians must distinguish between two critical states:

1. Hypoglycemia (Blood glucose $< 70 \text{ mg/dL}$): Symptoms include shakiness, sweating, confusion, and tachycardia. A common mnemonic is: "Cool and Clammy, Give Them Candy".
2. Hyperglycemia (Blood glucose $> 180 \text{ mg/dL}$): Symptoms include polyuria (excessive urination), polydipsia (excessive thirst), and blurred vision. A common mnemonic is: "Hot and Dry, Sugar High". Severe cases can lead to Ketoacidosis, characterized by fruity breath odor and rapid respirations.

Diabetes Insipidus (DI)

Unlike Diabetes Mellitus, DI is a water-balance disorder involving Antidiuretic Hormone (ADH), also known as vasopressin.

• Central DI: The hypothalamus or pituitary fails to produce/release enough ADH.
• Nephrogenic DI: The kidneys do not respond to ADH. Both result in polyuria and polydipsia with heavily diluted, almost colorless urine.

Acid-Base Balance

The body maintains a strict pH range of $7.35–7.45$. Metabolic homeostasis is managed through the regulation of bicarbonate ($\text{HCO}_3$) and hydrogen ions ($H^+$).

• Metabolic Acidosis: Characterized by a low pH and low $\text{HCO}_3$. The body may attempt to compensate by excreting $H^+$ or retaining $\text{HCO}_3$.
• Metabolic Alkalosis: Characterized by a high pH and high $\text{HCO}_3$.

Urinary System and Lab Values

The urinary system is vital for electrolyte balance and waste excretion. Clinical presentation often involves changes in micturition (urination).

Urinary Symptoms and Conditions

• Common Terms: Polyuria (excessive urine), Oliguria (low urine), Hematuria (blood in urine), and Dysuria (painful urination).
• Neurogenic Bladder: Resulting from neurological damage (e.g., Stroke, MS, Spinal Cord Injury), this can lead to various forms of incontinence.
• Urinary Tract Infection (UTI): Prevention includes hydration and proper hygiene (wiping front to back).

Critical Lab Values and Rehab Implications

Monitoring blood chemistry is vital for patient safety during exercise.

Hematology Overview

• White Blood Cells (WBC): $4,500 - 11,000 \text{ cells/µL}$. High levels suggest infection or inflammation; low levels ($< 5,000$) increase infection risk. Note: If WBC is low and the patient has a fever, DO NOT proceed with PT.
• Hemoglobin (Hgb): M: $13-18 \text{ g/dL}$, F: $12-16 \text{ g/dL}$. If Hgb is $< 8 \text{ g/dL}$, do not exercise.
• Hematocrit (Hct): M: $37-39%$, F: $36-46%$. If Hct is $< 25\%$, do not exercise.
• Platelets (PLC): $150,000 - 400,000 \text{ cells/µL}$. Low platelets increase bleeding risk; avoid high-intensity or contact activities.

Exam Alert: If a patient presents with sudden cognitive changes (confusion, lethargy) or neuromuscular distress (seizures, twitching) alongside abnormal sodium levels, stop treatment immediately as these may indicate cerebral edema.