Scurvy (Vitamin C Deficiency) - Diagnosis and Management Vitamin C is required for hydroxylation of proline residues on procollagen molecules, which support the triple-helix structure of collagen that underpins the integrity of: • Skin • Vessels • Mucous membranes • Bone Groups at risk for scurvy: • Inadequate intake of fresh fruit and vegetables • Persons with psychiatric illnesses • Eating disorders • Selective eating habits • Infants who consume only pasteurized milk • Children with autism spectrum disorder, persons with alcohol use disorder • Isolated elderly persons with poor nutrition Clinical Presentation: • General malaise and lethargy • Poor appetite and failure to thrive • Ill temper • Fever and tachypnea As the condition progresses, shortness of breath, wasting, anemia, edema, mucocutaneous changes, ocular and musculoskeletal symptoms develop. Psychiatric symptoms: • Mood disturbances • Depression • Cognitive impairment • Delusions Ocular: • Eye dryness and irritation • Subconjunctival, periorbital, or orbital hemorrhage Mouth: • Gingival hemorrhages • Loss of teeth Anemia: • Vitamin C deficiency can lead to iron and folate deficiencies • Vit C contributes to red-cell cytoskeleton protein beta-spectrin, which is crucial to the structure and integrity of the cell. The loss of beta-spectrin can contribute to nonimmune hemolysis MSK: • Hemarthrosis • Myalgias • Weakness • Muscle cramping Skin: • Petechia • Purpura • Perifollicular hemorrhages • Corkscrew hairs • Poor wound healing • Follicular hyperkeratosis DDX? • Petechiae, purpura, and ecchymoses due to capillaritis, cutaneous vasculitis, thrombocytopenia, or any other cause • Folliculitis • Gingivitis and periodontitis • ITP • Henoch-Schonlein purpura • DIC • Rocky Mountain spotted fever • Meningococcemia • Hypersensitivity vasculitis Treatment: • Supplementation with 1 g/day of oral vitamin C for 2 weeks #Scurvy #Pathophysiology #VitaminC #AscorbicAcid #Pathophysiology #Nutrition #Diagnosis #Management
