Abstract The development of coagulopathy is emerging as one of the most significant poor prognostic features in coronavirus disease (COVID)-19 pneumopathy. D-dimer, a protein product of fibrin degradation, has been found elevated in the most severe cases and correlated to mortality. Potentially involved factors in the impairment of coagulation caused by viral infection include the dysregulated inflammatory response, platelet, and endothelial dysfunction with impaired fibrinolysis. Heparin is an anticoagulant molecule that also showed anti-inflammatory properties and a potential antiviral effect. The use of low-molecular-weight heparin could prevent thromboembolic complications in COVID-19 pneumopathy. However, the correct timing of prophylaxis according to the stage of COVID-19 disease and the appropriate therapeutic dosage to use in severe cases needs further researches.

Resumen El desarrollo de coagulopatía se reconoce como una de las complicaciones y características clínicas más significativas asociadas a un pronóstico desfavorable en la neumopatía por enfermedad por coronavirus (COVID)-19. El dímero D, un producto proteico de la degradación de la fibrina se ha encontrado elevado en los casos más graves y correlacionado con elevación en la mortalidad. Los factores potencialmente involucrados en el deterioro de la coagulación causada por una infección viral incluyen una respuesta inflamatoria desregulada, las plaquetas y la disfunción endotelial con fibrinolisis alterada. La heparina es una molécula anticoagulante que también ha mostrado propiedades antiinflamatorias y un posible efecto antiviral. El uso de heparina de bajo peso molecular podría prevenir complicaciones tromboembólicas en la neumopatía por COVID-19; sin embargo, el momento correcto de la profilaxis de acuerdo con la etapa de la enfermedad COVID-19 y la dosis terapéutica adecuada para usar en casos severos requiere todavía más investigación.

OBJECTIVE: Refeeding syndrome occurs in patients with severe malnutrition when refeeding begins after a long period of starvation. This syndrome increases the risk of clinical complications and mortality. Hypophosphatemia is considered the primary characteristic of the syndrome. The aim of our study was to investigate the presence of other electrolyte alterations in patients with cancer during the early stage of refeeding. METHODS: In this observational study, we enrolled 34 patients with cancer of the upper aerodigestive tract receiving upfront radiotherapy who were also enrolled in a nutrition program. A caloric intake assessment, anthropometric measurements and biochemical laboratory tests were performed. RESULTS: Significant weight loss (∼20%) was found in these patients. In the patients receiving artificial nutrition, we found lower levels of potassium and total protein compared with those who were fed orally (p = 0.03 for potassium and 0.02 for protein, respectively). Patients on enteral tube feeding had a higher caloric intake compared with those who were fed orally (25±5 kcal/kg/day vs. 10±2 kcal/kg/day). CONCLUSION: Hypokalemia, like hypophosphatemia, could be a complication associated with refeeding in patients with cancer. Hypokalemia was present in the early stages of high-calorie refeeding.