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For further information, see CMDT Part 29-16: Vitamin C (Ascorbic Acid) Deficiency

Key Features

  • Most commonly due to dietary inadequacy among older patients and patients with chronic alcohol use disorder

  • 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

    • 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

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