Results

Clin Path

Results of the UA/CBC/ Chemistry w/electrolytes

Abnormal results are as follows

Mild hyperglycemia Ð possibly due to stress/corticosteroid response to trauma or by 
administration of prednislone.

Hyponatremia and hypochloridemia, anemia Ð Loss of blood and fluid via 
internal/external hemorrhage.  Replaced blood volume with lactated ringers which caused 
a possible hemodilution of sodium, chloride and RBC.  Hyponatremia can also be caused 
by bladder rupture due to its loss from blood plasma, but there are no other abnormalities 
to support this (inflammatory leukogram).

Hyperphosphatasemia Ð Increase in ALP due to a variety of factors.  Since it is only a 
mild increase, it is probably not due to cholestasis.  If cholestasis was the problem, we 
would also expect to see an increase in ALT as well.  Rather, the increase in ALP is most 
likely attributed to either the bone isoform (which occurs with an increase in osteoblastic 
activity) or induced by endogenous/exogenous corticosteroids.

SG 1.025 Ð slight hypersthenuria, renal mechanisms are intact.

Trace bilirubinuria/hematuria/urobilinogenuria Ð With excess free hemoglobin in the 
blood system due to extravascular hemolysis (from hemorrhage), the hemoglobin-
haptoglobin metabolism system is overwhelmed.  Free hemoglobin is released in the 
urine and seen as blood.  This may also cause slight kidney damage (slight 
hypersthenuria).  Trauma to the bladder or urethra should also be considered.  Another 
UA should be done in about a week to see if blood is gone from urine.  The excess 
bilirubinemia is from the breakdown of hemoglobin.  Loss of iron extravascularly could 
be compounding the anemia problem.  Urobilinogen is a product of conjugated bilirubin 
and is also increased.

There was no increase in WBC count, which leads us to believe that there is no 
inflammatory response going on.  

Radiograph analysis

Radiographs showed a mid-diaphyseal fracture in the left femur and right tibia.  Both 
fractures were comminuted, complete and closed.  Soft tissue swelling was noted around 
the fracture sites.  No dislocatation of any of the joints was noted.  Multiple bone 
fragments were seen in each fracture.  You might expect to see increased bone density 
near the fracture sites, but it has only been three days since the accident, and callus 
formation occurs after 14 days.