Vitamin C (Ascorbic Acid) Deficiency (Scurvy)

Ascorbic acid is essential for the formation of normal collagen

defects in collagen produces the metabolic and clinical manifestations of scurvy.
Alterations in collagen formation are due to failure to incorporate hydroxyproline and
proline.
Vitamin C
is a reducing agent
is easily oxidized and destroyed by heating
Ascorbic acid deficiency may also be a factor in some cases of megaloblastic anemia by
interfering in the conversion of folic acid or other conjugates
ETIOLOGY.
breast milk contains ascorbic acid and is a source of vitamin C.
PATHOLOGY.
During vitamin C deficiency, formation of collagen and of chondroitin sulfate is
impaired.
Hemorrhage
defective tooth dentin,
loosening of the teeth are caused by deficient collagen.
Because osteoblasts no longer form their normal intercellular substance (osteoid),
endochondral bone formation ceases.
bony trabeculae become brittle and fracture easily.
periosteum becomes loosened,
subperiosteal hemorrhages occur, at the ends of the femur and tibia.
scurvy shows
degeneration of skeletal muscles
cardiac hypertrophy
bone marrow depression
adrenal atrophy.
CLINICAL MANIFESTATIONS.
age 624 mo
symptoms = irritability, tachypnea, digestive disturbances, and loss of appetite appear.
general tenderness,

in the legs when the infant is picked up

when the diaper is changed.
pain results in pseudoparalysis,
legs assume the typical frog position
hips and knees are semiflexed
feet rotated outward.
subperiosteal hemorrhage can be palpated at the end of the femur.
facial expression is apprehensive.
in the gums, = bluish purple, spongy swellings
rosary at the costochondral junctions
a depression of the sternum
angulation of scorbutic beads is usually sharper than that of a rachitic rosary.
Petechial hemorrhages occur in the skin and mucous membranes.
Hematuria, melena, and orbital or subdural hemorrhages
fever
Anemia = inability to utilize iron or folic acid
Wound healing delayed,
healed wounds may break down.
Swollen joints and follicular hyperkeratosis
X ray fnding
long bones, at their distal ends,
simple atrophy of bone.
cortex is reduced
epiphyseal ends are outlined.
The white line of Fraenkel, = zone of well-calcified cartilage, irregular thickened white
line at the metaphysis.
The epiphyseal centers of ossification have a ground-glass appearance
DIAGNOSIS.
clinical picture,
roentgenographic appearance of the long bones,
history of poor intake of vitamin C. = boiling fruit juice.
Laboratory tests
asting vitamin C level of the blood plasma
ascorbic acid concentration in the white cellplatelet layer (buffy layer) of centrifuged
oxalated blood.
nonspecific aminoaciduria
Prothrombin time may be increased.
PROGNOSIS.

recovery occurs rapidly

PREVENTION.
citrus fruits and juices
TREATMENT.
daily therapeutic dose is 100200 mg orally or parenterally.
SCURVY (VITAMIN C OR ASCORBIC ACID DEFICIENCY)
presents with
follicular hyperkeratosis
coiling of hair on the upper arms, back, buttocks, and lower extremities.
Perifollicular erythema and hemorrhage, on the legs,
swollen, erythematous gums
stomatitis;
subperiosteal hematomas
best method for confirmation of a diagnosis of scurvy is a trial of vitamin C
supplementation.

Nelson Textbook of Paediatrics

16th Edition (2000), W.B. Saunders. All rights reserved.
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