Vitamin C Deficiency

Key Features

• Most commonly due to dietary inadequacy among patients of lower socioeconomic status, elderly, and patients with chronic alcoholism

• Persons who smoke cigarettes are also at risk as well as persons who have chronic illnesses such as cancer and chronic kidney disease

Clinical Findings

• Early: nonspecific malaise and weakness

• Late: scurvy

• Initial characteristics of scurvy

  • Perifollicular hemorrhages

  • Perifollicular hyperkeratotic papules

  • Petechiae and purpura

  • Splinter hemorrhages

  • Bleeding gums

  • Hemarthroses

  • Subperiosteal hemorrhages

• Characteristics of late scurvy

  • Edema

  • Oliguria

  • Neuropathy

  • Intracerebral hemorrhage

  • Death

• Anemia is common

• Wound healing is impaired

Diagnosis

• Characteristic skin lesions

• Atraumatic hemarthrosis

• Plasma ascorbic acid levels low, typically < 0.1 mg/dL

Treatment

• Ascorbic acid (vitamin C), 300–1000 mg orally once daily

• Supplemental vitamin C has no benefit on cardiovascular disease or cancer outcomes