Which patient requires close laboratory monitoring after starting tube feeding?

The patient who requires close laboratory monitoring after starting tube feeding is the one with chronic kidney disease. This condition significantly impacts fluid and electrolyte balance, which can be further complicated by the introduction of tube feeding. Patients with chronic kidney disease are often on specific diets to manage their potassium, phosphorus, and sodium levels, and tube feeding formulas may not align with these dietary restrictions.

In addition to monitoring electrolytes, renal function tests such as serum creatinine and blood urea nitrogen (BUN) should be closely observed because tube feedings may contribute to volume overload, further stressing the kidneys. Adjustments in the tube feeding regimen might be necessary based on laboratory results to prevent complications such as hyperkalemia, hyperphosphatemia, and fluid overload.

Compared to individuals with diabetes or heart failure, who also require careful management, the consequences of inadequate monitoring and adjustments in a patient with chronic kidney disease are more immediate and severe, making this population particularly high-risk when beginning tube feeding. The alcoholic with decreased intake would likely require monitoring as well but typically does not pose the same immediate risk in terms of laboratory abnormalities directly related to tube feeding initiation.