Pharmacology Book

http://www.fpnotebook.com/

Vitamin C DeficiencyAka: Scurvy

Advertisement

  1. See Also
    1. Vitamin C
  2. Pathophysiology: Vitamin C Deficiency
    1. Increased fragility of capillaries
    2. Poor wound healing
  3. Risk factors
    1. Elderly edentulous patients who cook for themselves
    2. Alcoholism
    3. Mental illness
    4. Infant on processed milk without supplementation
    5. Unusual dietary habits
  4. Symptoms
    1. Fatigue
    2. Children
      1. Irritability
      2. Tachypnea
      3. Decreased Appetite
      4. Leg tenderness
    3. External bleeding
      1. Hematuria
      2. Melena
  5. Signs: Children and Adults
    1. Purpura (saddle distribution)
      1. Perifollicular Petechiae
      2. Onset on back of lower extremities
      3. Coalesce into Ecchymoses
    2. Hemorrhages
      1. Hemorrhages into muscles of extremities
      2. Hemorrhages into joints
      3. Splinter Hemorrhages into nail beds
      4. Gingival hemorrhages
      5. Visceral hemorrhages
      6. Intracranial Hemorrhage (especially children)
        1. Subdural hemorrhage
        2. Retrobulbar hemorrhage
        3. Subarachnoid Hemorrhage
    3. Gingivitis (only in patients with teeth)
      1. Bluish purple spongy swellings
      2. Most prominent near incisors
    4. Other changes
      1. Poorly healing wounds
      2. Xerosis
    5. Late stage changes
      1. Jaundice
      2. Peripheral Edema
      3. Fever
  6. Signs: Children (Bone changes)
    1. Changes in addition to those above
    2. Long bone periosteal changes
      1. Epiphyseal separation with painful swellings
      2. Bowing of long bones
    3. Sunken sternum
      1. Forms scorbutic rosary at costochondral margin
  7. Differential Diagnosis
    1. Oral changes (Xerostomia)
      1. Sjogren's Syndrome
    2. Chest changes with sunken sternum
      1. Rickets (Rachitic Rosary)
    3. Arthralgias
      1. Rheumatic Fever
      2. Septic Joint
      3. Osteomyelitis
    4. Purpura
      1. Henoch-Schonlein Purpura
      2. Thrombocytopenic Purpura
  8. Radiology
    1. Epiphyseal separation
    2. Distal long bone changes (especially at knee)
      1. Ground-glass appearance of bone
      2. Cortex decreased to pencil point width
  9. Labs
    1. Ascorbic acid concentration in buffy layer
    2. Urine Aminoaciduria
    3. Complete Blood Count
      1. Normocytic Normochromic Anemia
    4. Prothrombin Time increased
  10. Management
    1. Vitamin C (Ascorbic acid) Replacement (preferred)
      1. Adults: 200 mg qd
      2. Children: 100 to 200 mg qd
    2. Dietary Vitamin C
      1. Orange Juice or Tomato Juice >4 ounces per day
  11. Complications
    1. Risk of sudden death in late disease
  12. Prevention
    1. See Vitamin C for recommended daily needs
  13. References
    1. Behrman (2000) Nelson Pediatrics, p. 182-4
    2. Cotran (1999) Robbins Pathologic Basis, p. 449-50
    3. Rees in Lee (1999) Wintrobe's Hematology, p. 1638
    4. Wilson (1991) Harrison's Internal Medicine 438-9
    5. Hirschmann (1999) J Am Acad Dermatol 41(6):895
    6. Rajakumar (2001) Pediatrics 108(4):E76

Scurvy (C0036474)

Definition (MSH)An acquired blood vessel disorder caused by severe deficiency of vitamin C (ASCORBIC ACID) in the diet leading to defective collagen formation in small blood vessels. Scurvy is characterized by bleeding in any tissue, weakness, ANEMIA, spongy gums, and a brawny induration of the muscles of the calves and legs.
ConceptsDisease or Syndrome (T047)
ICD9267
EnglishHYPOASCORBEMIA, Scorbutus, Scurvies, Scurvy
Spanishescorbuto
CreditsDerived from the NIH UMLS (Unified Medical Language System)



Navigation Tree