OVERVIEW oF SCURVY

  • Vitamin C (ascorbic acid):
    • An essential water-soluble vitamin (humans cannot synthesize it).
    • Found in citrus fruits, tomatoes, potatoes, cabbage, spinach, Brussels sprouts, cauliflower, broccoli, strawberries.
    • Scurvy may appear after ~3 months of a vitamin C–free diet.

BIOCHEMICAL ROLE

  • Ascorbic acid is the enolic form of α-ketolactone.
  • Functions as a cofactor/cosubstrate in reactions using iron or copper (provides reducing equivalents).
  • Key enzymatic processes include:
    • Collagen synthesis (hydroxylation of proline & lysine residues).
    • Carnitine synthesis (cofactor).
    • Conversion of dopamine to norepinephrine (dopamine β-hydroxylase).
  • Absorption: Takes place in jejunum and ileum; blood levels are regulated by renal excretion.

SCURVY

Definition & History

  • Nutritional deficiency disorder caused by lack of vitamin C.
  • Known since antiquity; historically linked to prolonged sea voyages with no fresh food.
  • Dr. James Lind (1754) linked intake of oranges/lemons to preventing scurvy.

Clinical Features

  1. General Symptoms:
    • Onset is insidious.
    • Weakness, malaise, shortness of breath.
    • Bone pain, myalgias, arthralgias, edema, neuropathy.
    • Vasomotor instability.
  2. Skin & Connective Tissue:
    • Impaired collagen → defective wound healing.
    • Hyperkeratotic papules, perifollicular hemorrhages, follicular hyperkeratosis (coiled/frayed hair).
    • Petechial hemorrhages (often start on lower extremities).
    • Rumpel-Leede sign (abnormal capillary fragility): inflating BP cuff causes many petechiae.
    • Large ecchymoses or even proptosis from retrobulbar hemorrhage.
    • Subungual “splinter” hemorrhages.
  3. Joints & Bones:
    • Hemorrhage into joints → pain, swelling, limited movement.
    • In infants: subperiosteal hemorrhages → “frog leg” posture, “pseudoparalysis” from pain.
    • Impaired osteoblast function → stunted growth in children.
  4. Gingival Changes:
    • Gums become swollen, reddish-blue, spongy, friable.
    • Loosening/falling of teeth.
  5. Severe Cases:
    • Possible massive cerebral hemorrhages with hyperpyrexia, tachycardia, cyanosis, hypotension, Cheyne-Stokes respirations, leading to death.

DIAGNOSIS

  • Scurvy is seen in severely malnourished individuals (e.g., certain alcoholics).
  • Laboratory: Serum ascorbic acid level <0.3 mg/dL indicates severe deficiency (normal: 0.6–2.0 mg/dL).

TREATMENT

  • Ascorbic acid supplementation:
    • Typically 500 mg/day until resolution of signs/symptoms.
  • Address underlying causes of dietary deficiency or malabsorption.

PREVENTION

  • Recommended daily allowance:
    • Men: 90 mg/day
    • Women: 75 mg/day
    • Pregnant/Lactating women: ~120 mg/day
  • Achievable with balanced diets including citrus fruits and vegetables.

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