Scurvy

Disease class: Haemostatic disorders

Nutrients

A disease caused by deficiency of vitamin C (ascorbic acid).

 

Risk factors

• Poverty
• Alcoholism
• Psychiatric disorders
• Malabsorption
• Dialysis 
• Old age 
• Neglect

 

Pathogenesis

Humans lack a functional L-gulonolactone oxidase (GULO) enzyme and cannot synthesis vitamin C. 
Vitamin C is essential for biosynthesis in many pathways in human metabolism.
Without vitamin C, there is insufficient synthesis of collagen.

 

Symptoms

• Leg swelling
• Bleeding gums
• Tooth loss
• Hair changes
• Joint pain
• Muscle pain
• Bone pain
• Fatigue
• Weakness
• Depression
• Impaired wound healing
• Skin bleeding
• Haematuria
• Haematemesis
• Predisposition to infections

 

Signs

• Petechiae
• Ecchymosis
• Joint effusions (haemarthrosis)
• Swelling over long bones (subperiosteal haemorrhage)
• Scorbutic rosary (sternum displaced inwards, costochondral separation)

 

Investigations

• Full blood count : anaemia
• Radiographs (wrist, knee, sternal end of ribs) : various signs of scurvy

Management 

• Replenishment
• Oral vitamin C at 250mg QID x 1 week

• Dietary changes
• Citrus fruits
• Potatoes
• Green vegetables