Makindo Medical Notes

⚠️ Vitamin C requirements are increased by fever, inflammation, diarrhoea, smoking 🚬, hyperthyroidism, iron deficiency, cold or heat stress ❄️🔥, surgery, burns, and protein deficiency.

🧾 About

• Always check BNF (or equivalent) for prescribing advice.
• Scurvy is the clinical syndrome from dietary deficiency of vitamin C (ascorbic acid).
• Humans cannot synthesise vitamin C and depend entirely on diet.

📜 History

• Scurvy was a limiting factor in long sea voyages, often killing many sailors after 2–3 months at sea.
• In 1747, James Lind showed that scurvy could be cured with citrus fruits 🍋.
• Ascorbic acid was first isolated by Albert Szent-Györgyi in 1928 (Nobel Prize 1937 🏅).

⚙️ Aetiology & Function

• Vitamin C is an electron donor / reducing agent.
• Provides antioxidant protection against oxidative stress & UV-induced photodamage 🌞.
• Essential co-factor for proline & lysine hydroxylases, stabilising collagen structure.
• Promotes collagen gene expression ➡️ affects dentine, osteoid, and vessel wall tissues.

🩺 Clinical Features of Scurvy

• Mood: apathy, irritability, depression.
• Oral: swollen, bleeding gums, friability, infection, loose teeth 🦷.
• Skin: perifollicular hyperkeratotic papules, perifollicular haemorrhages, purpura & ecchymoses.
• Ocular: scleral icterus (late, due to haemolysis).
• Musculoskeletal: bone pain, fractures, dislocations in children; bleeding into joints and muscles.

🔍 Differentials

• Gingivitis & periodontal disease.
• Haemorrhagic disorders (platelet/coagulation defects).
• Connective tissue diseases (e.g. Ehlers–Danlos, osteogenesis imperfecta).
• Protein-energy malnutrition.

🧪 Investigations

• FBC: may show anaemia (normocytic or macrocytic).
• Plasma vitamin C levels: <0.2 mg/dL (<11 µmol/L) indicate deficiency (not commonly tested).

💊 Management

• Scurvy is most common in alcoholics and the elderly consuming <10 mg/day vitamin C.
• Treatment: Ascorbic acid 100–500 mg PO TDS for 1–2 weeks, then maintenance long-term (BNF guidance).
• Dietary: 5 servings of fruit/veg daily provide >200 mg/day 🍊🥦🥭.

📚 References

• BNF – Ascorbic Acid
• Review Article: Vitamin C Deficiency