Which of the following combinations may indicate overfeeding in an adult receiving enteral nutrition?

• A. Hyperglycemia, weight gain, accumulation of carbon dioxide, and hepatobiliary effects
• B. Hypoglycemia, weight loss, dehydration, reduced liver enzymes
• C. Normal glucose, stable weight, no CO2, normal biliary function
• D. Hypoglycemia, edema, hyperlipidemia, decreased appetite

Answer: (C)

Overfeeding with enteral nutrition shows up when there is an excess of calories, especially from carbohydrates, leading to several interrelated metabolic effects. When the carbohydrate load is too high, blood glucose tends to rise (hyperglycemia) as the body cannot fully utilize or store all of the incoming glucose. The surplus calories also promote weight gain, reflecting the net energy surplus. In ventilated or energy-need assessments, the extra carbohydrate increases CO2 production, so patients can develop higher CO2 levels. The liver and biliary system respond to the energy excess with fat synthesis and possible hepatobiliary stress, manifesting as hepatobiliary changes. Taken together, hyperglycemia, weight gain, increased CO2 production, and hepatobiliary effects form a pattern that strongly suggests overfeeding.

Patterns that don’t fit overfeeding well include hypoglycemia with weight loss, dehydration or reduced liver enzymes, or normal glucose with stable weight and normal CO2 and biliary function, which point away from excessive caloric delivery. Edema and hyperlipidemia with decreased appetite can occur in other contexts, but they don’t collectively align as clearly with the classic signs of caloric excess from enteral feeding.