06/18/2026
Why does low sodium, low potassium, and a suppressed Na/K ratio represent stress physiology on an HTMA?
To answer that, we have to start with the body's survival response.
When a horse encounters a stressor, the adrenal glands release cortisol. One of cortisol's jobs is to increase the amount of glucose available in the bloodstream. Glucose is the brain's primary fuel source, and it also provides energy for the muscles needed to fight, flee, or otherwise survive the situation.
This response is designed to be temporary.
The problem is that many domestic horses are exposed to stressors day after day. Pain, confinement, social tension, metabolic dysfunction, environmental challenges, intense training, transportation, competition schedules, and chronic inflammation can all keep the stress response activated long after it should have shut off.
When stress becomes chronic, the HPA axis remains engaged and cortisol production becomes dysregulated.
At first, cortisol may remain elevated for extended periods. High cortisol comes with consequences.
Blood flow is diverted away from the digestive tract and toward tissues needed for survival. Protective stomach mucus production decreases, the risk of gastric ulceration increases, and gut motility changes. Intestinal barrier function can become compromised, allowing unwanted substances to enter the bloodstream and contribute to systemic inflammation.
The immune system also begins to suffer. Horses may become more susceptible to infections, chronic allergies, and delayed healing.
Meanwhile, cortisol continues increasing blood glucose levels.
Under natural conditions, a horse experiencing a true fight-or-flight response would use that glucose through intense physical activity. The muscles would rapidly consume the fuel that was released.
Domestic horses often do not get that opportunity.
The stress response is activated, but the physical completion of the response never occurs. Glucose remains elevated, increasing the workload on the pancreas, which must continually produce insulin to manage blood sugar levels.
It's important to understand that not all stress is harmful. Exercise is a form of stress, but when applied appropriately and followed by adequate recovery, it helps build resilience. Muscle contraction increases glucose uptake independent of insulin, which is one reason regular movement can be especially beneficial for horses with metabolic dysfunction or Cushing's. The problem is when stress becomes chronic and recovery never fully occurs.
For some horses, chronic stress comes from pain, inflammation, digestive dysfunction, or environmental challenges. For others, it may come from intense training schedules, frequent hauling, competition demands, and inadequate recovery. The source of the stress matters less than the body's ability to adapt and recover from it.
Over time, chronic stress begins to deplete the body's reserves.
On an HTMA, this often appears as declining sodium and potassium levels along with a suppressed sodium-to-potassium ratio.
These minerals are closely connected to adrenal function and the body's ability to adapt to stress.
As sodium and potassium decline, the effects extend far beyond the adrenal glands.
Sodium is essential for maintaining membrane electrical potential and the transport mechanisms that move nutrients into cells. It also contributes to the production of stomach acid, which is necessary for proper protein digestion.
Potassium depletion can contribute to increasing thyroid hormone resistance and the slowing of metabolic processes that often accompany chronic stress states.
From the body's perspective, this is an adaptive response. Slowing metabolism can be a way of conserving resources when stress has exceeded the system's ability to cope.
The problem is that what helps survival in the short term becomes a liability when it persists for months or years.
What began as a normal survival response eventually becomes a pattern of reduced resilience, impaired recovery, digestive dysfunction, immune compromise, metabolic slowing, and chronic fatigue.
This is why low sodium, low potassium, and a suppressed Na/K ratio on an HTMA are rarely just mineral problems.
They are often signs of a horse that has been carrying a stress burden for far too long.