Ascorbic acid is essential for the formation of normal collagen
defects in collagen produces the metabolic and clinical manifestations of scurvy. Alterations in collagen formation are due to failure to incorporate hydroxyproline and proline. Vitamin C is a reducing agent is easily oxidized and destroyed by heating Ascorbic acid deficiency may also be a factor in some cases of megaloblastic anemia by interfering in the conversion of folic acid or other conjugates ETIOLOGY. breast milk contains ascorbic acid and is a source of vitamin C. PATHOLOGY. During vitamin C deficiency, formation of collagen and of chondroitin sulfate is impaired. Hemorrhage defective tooth dentin, loosening of the teeth are caused by deficient collagen. Because osteoblasts no longer form their normal intercellular substance (osteoid), endochondral bone formation ceases. bony trabeculae become brittle and fracture easily. periosteum becomes loosened, subperiosteal hemorrhages occur, at the ends of the femur and tibia. scurvy shows degeneration of skeletal muscles cardiac hypertrophy bone marrow depression adrenal atrophy. CLINICAL MANIFESTATIONS. age 624 mo symptoms = irritability, tachypnea, digestive disturbances, and loss of appetite appear. general tenderness,
in the legs when the infant is picked up
when the diaper is changed. pain results in pseudoparalysis, legs assume the typical frog position hips and knees are semiflexed feet rotated outward. subperiosteal hemorrhage can be palpated at the end of the femur. facial expression is apprehensive. in the gums, = bluish purple, spongy swellings rosary at the costochondral junctions a depression of the sternum angulation of scorbutic beads is usually sharper than that of a rachitic rosary. Petechial hemorrhages occur in the skin and mucous membranes. Hematuria, melena, and orbital or subdural hemorrhages fever Anemia = inability to utilize iron or folic acid Wound healing delayed, healed wounds may break down. Swollen joints and follicular hyperkeratosis X ray fnding long bones, at their distal ends, simple atrophy of bone. cortex is reduced epiphyseal ends are outlined. The white line of Fraenkel, = zone of well-calcified cartilage, irregular thickened white line at the metaphysis. The epiphyseal centers of ossification have a ground-glass appearance DIAGNOSIS. clinical picture, roentgenographic appearance of the long bones, history of poor intake of vitamin C. = boiling fruit juice. Laboratory tests asting vitamin C level of the blood plasma ascorbic acid concentration in the white cellplatelet layer (buffy layer) of centrifuged oxalated blood. nonspecific aminoaciduria Prothrombin time may be increased. PROGNOSIS.
recovery occurs rapidly
PREVENTION. citrus fruits and juices TREATMENT. daily therapeutic dose is 100200 mg orally or parenterally. SCURVY (VITAMIN C OR ASCORBIC ACID DEFICIENCY) presents with follicular hyperkeratosis coiling of hair on the upper arms, back, buttocks, and lower extremities. Perifollicular erythema and hemorrhage, on the legs, swollen, erythematous gums stomatitis; subperiosteal hematomas best method for confirmation of a diagnosis of scurvy is a trial of vitamin C supplementation.
Nelson Textbook of Paediatrics
16th Edition (2000), W.B. Saunders. All rights reserved. Buy this book at 10% discount and The Isabel Medical Charity will also receive a 10% charitable donation directly from the publishers
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