Interpretation of Specialty Exams

Clinical Pathology:

The patient is slightly hyperglycemic, which is probably the result of stress-induced 
gluconeogenesis.  The hyperphosphatasemia is probably due to an increase in the bone 
isoform of this enzyme, which increases with osteoblast activity (resulting from 
reparative efforts).

The patient is hyponatremic and hypochloridemic (most of the conditions that cause the 
former cause the later).  These ions were likely lost in blood and plasma via wounds from 
the hit.  When the patient was rehydrated, the fluids administered diluted the remaining 
ions.  Hemorrhage has also caused an anemia (hematocrit is low).

The leukogram is difficult to interpret since no total white cell count was given and the 
cell types are listed as percentages.  We expect neutrophils to be the largest cell type in 
numbers and it is.  No bands indicates no left shift, so inflammation is established (the 
bone marrow is caught up), if present at all (we expect that it would be).

The urine is slightly concentrated, which can certainly be normal.  Amorphous 
crystalluria and a few epithelial cells can also be normal in the dog (depending on how 
the sample was taken).

A 1+ bilirubinuria can also be normal with a concentrated urine in dogs.  This patient's 
urine is only slightly concentrated, and bilirubin crystals are also found, so the bilirubin 
might possibly be resulting from clean-up and digestion of released red cells in internal 
hemorrhage.

The positive occult blood on the dipstick test could indicate hematuria, hemoglobinuria, 
or myoglobinuria.  Muscle destruction is likely, so myoglobinuria is a fair possibility.

Radiographs

The radiographs reflect a midshaft fracture of the left femur with complete dissociation 
and bony fragments and a midshaft fracture of the right tibia showing less need for 
reduction than the femur, but bony fragments surrounding.