Diagnosis and Pathophysiology:

Left midshaft femur- multiple complete fractures with fragmentation.
Right tibia and fibula- complete fracture with fragmentation.
All fractures are unstable.

This dog is hyperglycemic due to a stress response which caused endogenous 
corticosteroid release and also due to the exogenous corticosteriods that were 
administered the day of initial examination.  
He has a hyponatremic dehydration, which resulted in the hyperproteinemia and 
hyperglobulinemia.   This dehydration is probably caused by the loss of blood (anemia), 
which causes an equivalent loss of water and sodium.  However, when the patient drinks 
or receives fluids he will restore the water volume without restoring the sodium volume 
in the blood. In this case the patient received Lactated Ringers Solution and is most likely 
drinking at the same time, therefore diluting out the sodium in the blood.  
Hypochloridemia generally follows hyponatremia unless the patient is vomiting, which is 
not stated in the history.   
The slight aciduria could have several causes; could be due to the hyponatremia 
dehydration, a diet rich in protein, which causes sulfur containing amino acids in the diet 
causing an aciduria, or administration of Lactated Ringers Solution.

The dehydration and anemia caused hepatocellular hypoxia which led to hepatocellular 
damage and leakage of the alanine aminotransferasemia
Secondary cause could be blunt trauma to the liver, leading to hepatocellular swelling and 
leakage.
Increased alkaline phosphatase activity could be induced by blunt trauma to the liver 
which caused a  decrease in functional hepatic mass due to hepatocellular swelling and 
subsequent necrosis.  This is supported by the slight bilirubinuria (which typically 
follows cholestasis) and urobilinogen.  Cortocosteriods have also been shown to cause 
alkaline phosphatase induction in canines.  The stress of the accident and endogenous 
corticosteroid release as well as exogenous corticosteriod administration, may have 
caused this hyperphosphatasemia in the patient.  Finally, osteoclast and osteoblast 
activity (due to the fracture) could have caused an increase in alkaline phosphatase levels.
The trace hematuria is probabaly a result of the initial blunt trauma of the accident.