Vitamin C Deficiency

Aka: Vitamin C Deficiency, Ascorbic Acid Deficiency, Scurvy

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II. Pathophysiology: Vitamin C Deficiency

  1. Increased fragility of capillaries
  2. Poor Wound Healing

III. Risk factors

  1. Elderly edentulous patients who cook for themselves
  2. Alcoholism
  3. Mental illness
  4. Institutionalized patients
  5. Infant on processed milk without supplementation
  6. Unusual dietary habits
  7. Malabsorption syndromes

IV. Symptoms

  1. Children
    1. Irritability
    2. Tachypnea
    3. Decreased Appetite
    4. Leg tenderness
  2. External bleeding
    1. Gingival erythema and bleeding
    2. Hematuria
    3. Melena
  3. Other symptoms
    1. Fatigue
    2. Mood changes
    3. Joint Pain
    4. Orthostasis

V. Signs: Children and Adults

  1. Purpura (saddle distribution of nonpalpable lesions)
    1. Perifollicular Petechiae
    2. Onset on back of lower extremities (dependent regions)
    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
    3. Hyperkeratosis
    4. Alopecia
    5. Corkscrew hairs (or crinkly hairs, coiled hairs)
    6. Painful joint effusions
  5. Late stage changes
    1. Jaundice
    2. Peripheral Edema
    3. Fever

VI. 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

VII. 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

VIII. 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

IX. Labs

  1. Ascorbic Acid concentration in buffy layer
  2. Urine Aminoaciduria
  3. Complete Blood Count
    1. Normocytic Normochromic Anemia
    2. Platelet Count is typically normal
  4. Prothrombin Time increased

X. Management

  1. Vitamin C (Ascorbic Acid) Replacement (preferred)
    1. Doses in excess of 1000 mg are not absorbed
    2. Adults: 200 mg orally daily
    3. Children: 100 to 200 mg orally daily
  2. Dietary Vitamin C
    1. Orange Juice or Tomato Juice >4 ounces per day

XI. Complications

  1. Risk of sudden death in late disease

XII. Prevention

  1. See Vitamin C for recommended daily needs

XIII. 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. Rendon et al. (2017) Crit Dec Emerg Med 31(6): 15-21
  5. Wilson (1991) Harrison's Internal Medicine 438-9
  6. Hirschmann (1999) J Am Acad Dermatol 41(6):895-906 [PubMed]
  7. Rajakumar (2001) Pediatrics 108(4):E76 [PubMed]

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Related Studies

Ontology: Ascorbic Acid Deficiency (C0003969)

Definition (CSP) condition due to a deficiency of vitamin C.
Definition (MSH) A condition due to a dietary deficiency of ascorbic acid (vitamin C), characterized by malaise, lethargy, and weakness. As the disease progresses, joints, muscles, and subcutaneous tissues may become the sites of hemorrhage. Ascorbic acid deficiency frequently develops into SCURVY in young children fed unsupplemented cow's milk exclusively during their first year. It develops also commonly in chronic alcoholism. (Cecil Textbook of Medicine, 19th ed, p1177)
Concepts Disease or Syndrome (T047)
MSH D001206
ICD9 267
ICD10 E54
SnomedCT 124907004, 267493006, 154727008, 190638001, 76169001
English Ascorbic Acid Deficiencies, Ascorbic Acid Deficiency, Deficiencies, Ascorbic Acid, Deficiencies, Vitamin C, Deficiency, Ascorbic Acid, Deficiency, Vitamin C, Vitamin C Deficiencies, Vitamin C Deficiency, DEFIC VITAMIN C, ASCORBIC ACID DEFIC, DEFIC ASCORBIC ACID, vitamin C deficiency, vitamin C deficiency (diagnosis), Ascorbic Acid Deficiency [Disease/Finding], of vitamin c deficiency, ascorbic acid deficiency, deficiency of vitamin c, vitamin c deficiency, Deficiency of vitamin C, Ascorbic acid defic., Deficiency of ascorbic acid (disorder), Ascorbic acid (vitamin C) deficiency, Ascorbic acid deficiency, Vitamin C deficiency, Deficiency of ascorbic acid, Ascorbic acid deficiency (disorder), ascorbic acid; deficiency, deficiency; ascorbic acid, deficiency; vitamin, C, scorbutic, vitamin; deficiency, C
Dutch ascorbinezuurdeficiëntie, ascorbinezuur; deficiëntie, deficiëntie; ascorbinezuur, deficiëntie; vitamine, C, vitamine; deficiëntie, C, vitamine-C-deficiëntie, Tekort, Vitamine-C-, Vitamine-C-tekort, Ascorbinezuurdeficiëntie, Vitamine-C-deficiëntie
German Askorbinsaeuremangel, Vitamin C-Mangel, Vitamin-C-Mangel, Ascorbinsäuremangel
Portuguese Carência de ácido ascórbico, Carência de vitamina C, Deficiência de Ácido Ascórbico, Deficiência de Vitamina C
Spanish Déficit de ácido ascórbico, déficit de ácido ascórbico (trastorno), deficiencia de vitamina C, deficiencia de ácido ascórbico (trastorno), deficiencia de ácido ascórbico, hipovitaminosis C, Déficit de vitamina C, Deficiencia de Ácido Ascórbico, Deficiencia de Vitamina C
Japanese ビタミンＣ欠乏, ｱｽｺﾙﾋﾞﾝｻﾝｹﾂﾎﾞｳ, ﾋﾞﾀﾐﾝCｹﾂﾎﾞｳ, Ascorbic Acid欠乏症, アスコルビン酸欠乏症, ビタミンC欠乏症, Vitamin C欠乏症, アスコルビン酸欠乏
Swedish C-vitaminbrist
Czech vitamin C - nedostatek, kyselina askorbová - nedostatek, Deficit vitaminu C, Deficit kyseliny askorbové
Finnish Askorbiinihapon puutos
Italian Carenza di vitamina C, Carenza di acido ascorbico
Russian ASKORBINOVOI KISLOTY NEDOSTATOCHNOST', VITAMINA C NEDOSTATOCHNOST', АСКОРБИНОВОЙ КИСЛОТЫ НЕДОСТАТОЧНОСТЬ, ВИТАМИНА C НЕДОСТАТОЧНОСТЬ
Korean 아스코르빈산 결핍증
Croatian ASKORBINSKA KISELINA, NEDOSTATAK
Polish Hipowitaminoza C, Niedobór kwasu askorbinowego, Niedobór witaminy C
Hungarian C-vitamin hiány, Ascorbinsav-hiány
Norwegian C-vitaminmangel, Vitamin C-mangel, Askorbinsyremangel, Hypovitaminosis C
French Carence en vitamine C, Carence en acide ascorbique, Déficit en acide ascorbique
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: 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.
Concepts Disease or Syndrome (T047)
MSH D012614
ICD10 E54
SnomedCT 267493006, 190638001, 154727008, 238129003, 76169001
English Scorbutus, Scurvies, HYPOASCORBEMIA, SCURVY, VITAMIN C, INABILITY TO SYNTHESIZE, Scurvy, scurvy (diagnosis), scurvy, Scurvy [Disease/Finding], scurvies, Hypoascorbemias, Hypoascorbemia, Scurvy (disorder), scorbutus
Dutch scheurbuik, Scheurbuik, Scorbuut
Swedish Skörbjugg
Japanese ｶｲｹﾂﾋﾞｮｳ, 壊血病
Czech kurděje, Kurděje
Finnish Askorbiinihapon puutos
Russian SKORBUT, BARLOU BOLEZN', TSINGA, БАРЛОУ БОЛЕЗНЬ, СКОРБУТ, ЦИНГА
Italian Scorbutus, Scorbuto
Polish Szkorbut, Gnilec
Hungarian Scorbut
Norwegian Skjørbuk
French Hypoascorbémie, Scorbut
Spanish escorbuto, Escorbuto
German Avitaminose C, Scorbutus, Skorbut, Vitamin C-Mangelkrankheit
Portuguese Escorbuto
Derived from the NIH UMLS (Unified Medical Language System)

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