Which metabolic alteration is NOT associated with the development of tube feeding syndrome?

• A. Dehydration
• B. Hypernatremia
• C. Azotemia
• D. Ketonemia

Answer: (D)

Refeeding syndrome occurs when nutrition is restarted in a malnourished person, triggering a surge of insulin. This insulin drives glucose and electrolytes into cells, leading to low phosphate, potassium, and magnesium in the blood, along with fluid shifts that can cause edema and stress the kidneys. Those shifts explain why dehydration, azotemia, and even disturbances in fluid and electrolyte balance (like hypernatremia in some scenarios) can be seen during tube feeding. In contrast, ketone bodies rise during prolonged fasting as fat is broken down for energy; once carbohydrates are provided again, this fat-derived ketogenesis falls, so ketonemia is not a feature of refeeding syndrome.