Which metabolic alteration is NOT associated with tube feeding syndrome?

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

Answer: (D)

Ketonemia is not a typical feature of tube feeding syndrome. When enteral nutrition adequately meets energy and fluid needs, the body relies on the provided carbohydrates to supply glucose, which suppresses lipolysis and ketone production. In contrast, dehydration, azotemia, and hypernatremia are more directly linked to tube feeding—dehydration from insufficient free water or high-osmolality formulas, azotemia from a high protein load or prerenal effects of dehydration, and hypernatremia from too little free water relative to sodium or an overly concentrated formula. So the presence of ketones in the blood isn’t expected with standard tube feeding unless there’s an interruption in feeding or a markedly carbohydrate-restricted formula.