Vitamin C Deficiency (Scurvy)
Original Editors - Emily Buckingham, Martina Riney Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Top Contributors - Martina Riney, Emily Buckingham, Kim Jackson, Lucinda hampton, Elaine Lonnemann, WikiSysop, 127.0.0.1 and Claire Knott
Definition/Description[edit | edit source]
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Prevalence[edit | edit source]
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Characteristics/Clinical Presentation[edit | edit source]
Vitamin C deficiency can lead to the following signs and symptoms:
Anemia
Bleeding gums
Decreased ability to fight infection
Decreased wound-healing rate
Dry and splitting hair
Easy bruising
Gingivitis (inflammation of the gums)
Nosebleeds
Possible weight gain because of slowed metabolism
Rough, dry, scaly skin
Swollen and painful joints
Weakened tooth enamel
Associated Co-morbidities[edit | edit source]
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Medications[edit | edit source]
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Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
Plasma levels: A fasting serum ascorbic acid level greater than 0.6 mg/dL rules out scurvy. Scurvy generally occurs at levels below 0.1 mg/dL
Leukocyte levels: The level of vitamin C in leukocytes more accurately correlates to tissue stores compared with serum levels, because these cells are not affected acutely by circadian rhythm or dietary changes. A level of zero indicates latent scurvy. Levels of 0-7 mg/dL reflect a state of deficiency
Urinary levels: A more commonly used method is the ascorbic acid tolerance test, which quantitates urinary ascorbic acid over the 6 hours following an oral load of 1 g of ascorbic acid in water
Radiographic findings: in infantile scurvy are diagnostic and may show any of the following:
- Subperiosteal elevation
- Fractures and dislocation
- Alveolar bone reabsorption
- Ground-glass appearance of cortex
- The cortex becomes thin and the trabecular structure of the medulla atrophies and develops a ground-glass appearance. The zone of provisional calcification becomes dense and widened, and this zone is referred to as the white line of Fränkel. The epiphysis also shows cortical thinning and the ground-glass appearance.
Etiology/Causes[edit | edit source]
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Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
There are no direct physical therapy interventions for Scurvy. The patient may be referred to physical therapy for the treatment of impairments caused by Scurvy. These may include joint pain and stiffness, musculoskeletal pain, and musculoskeletal weakness, (particularly in the lower extremity).
Differential Diagnosis[edit | edit source]
Meningococcemia
Osteomyelitis
Pediatric Poliomyelitis
Pediatric Syphilis
Retinoblastoma Imaging
Rheumatic Fever
Rheumatoid Arthritis
Rocky Mountain Spotted Fever
Septic Arthritis
Case Reports/ Case Studies[edit | edit source]
Case Report
Authors: Cole JA, Warthan MM, Hirano SA, Gowen CW, Williams JV.
Abstract:
Scurvy, or hypovitaminosis C, is an uncommon condition that exists today primarily within certain unique populations - particularly elderly subjects, patients with neurodevelopmental disabilities or psychiatric illnesses, or others with unusual dietary habits.
This case highlights that the presence of scurvy should not be forgotten, because of its presence among susceptible populations. Scurvy can present with clinical manifestations that include dystrophic or corkscrew hairs, gingival hyperplasia, and weakened blood vessel walls, causing bleeding in the skin, joints, and other organs.
Patient Characteristics:
10 year old boy with autism and slight developmental delay
Current bruising and leg swelling
Subjective: Chief complaints include:
Persistent lower extremity bruising and swelling
Refusal to walk
Pain in lower extremities.
Examination:
Persistent bruising and swelling throughout lower extremity
Persistent petechial eruption on patient’s legs
Intermittent oozing of gums
Decreased hemoglobin and hematocrit and low serum iron (8.8 gdL and 26%)
Chest radiograph demonstrated mild diffuse osteoporosis
Hypertrophic and bleeding gingiva
MRI of knees revealed significant deep soft tissue inflammatory change.
Serum L-ascorbic acid level was deficient (<0.12 mg/dL)
Past Medical History:
Child was struck by a surfboard approximately 4 weeks earlier, causing bruising and swelling around his left knee.
Limited diet, eating only hamburgers, Wheat Chex, Pop Tarts, oyster crackers, and pancakes. Patient took no vitamins or supplements and drank only water.
Intervention: Pharmaceutical
Oral administration of 100 mg of L-ascorbic acid twice daily
Co-intervention:Daily multivitamin per nutrition consultation
Outcomes: Within 24 hours of starting the L-ascorbic acid patient showed clinical improvement.
Outpatient follow-up showed normalization of L-ascorbic acid levels and no remaining clinical features of scurvy.
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Resources
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