StatPearls [Internet].
Persevering with Training Exercise
Vitamin C deficiency, also called scurvy, is a illness primarily related to socioeconomic standing and entry to meals. Indicators and signs are sometimes readily seen in people who develop this illness. The basic constellation of corkscrew hairs, perifollicular hemorrhage, and gingival bleeding is extremely suggestive of vitamin C deficiency. This exercise opinions the historical past, medical manifestations, analysis, and remedy of vitamin C deficiency. This exercise highlights the function of the interprofessional group in caring for affected sufferers and selling consciousness concerning dietary deficiencies.
Targets:Assessment frequent examination findings related to vitamin C deficiency.Describe the pathophysiology of vitamin C deficiency.Summarize the steps to diagnose vitamin C deficiency.Clarify the significance of enhancing care coordination, with explicit emphasis on communication between interprofessional medical groups, to boost each preventative administration and immediate supply of care to sufferers with vitamin C deficiency.Earn persevering with training credit (CME/CE) on this subject.
Introduction
Scurvy is a medical syndrome that outcomes from vitamin C deficiency. Tales from pirates and British sailors made the illness notorious. This illness was first reported in 1550 BC when individuals precisely described the analysis and remedy utilizing onions and greens. Hippocrates formally termed the illness “ileos ematitis” with the outline, “the mouth feels bad; the gums are detached from the teeth; blood runs from the nostrils… ulcerations on the legs; some of these heal… skin is thin.” Within the 1700s, James Lind of the British Royal Navy decided the consumption of lemons and oranges led to remission of the illness, and in 1927, the construction of ascorbic issue was revealed, with the synthesis of ascorbic acid named vitamin C not lengthy after.[1][2][3][4]
The vitamin C pool within the physique is often depleted in 4-12 weeks if one stops the consumption of the vitamin. Ascorbic acid is affected by many elements that may impair absorption and its capabilities. One of the simplest ways to stop vitamin C deficiency is to eat vegatables and fruits repeatedly.
Etiology – “a vitamin c deficiency”
Most animals require no exogenous vitamin C. For people, nevertheless, vitamin C is an important vitamin. People lack the enzyme L-gulonolactone oxidase, and folks should ingest it. Subsequently, vitamin C deficiency and its manifestations have largely been a product of insufficient dietary consumption. Vitamin C is of course present in recent vegatables and fruits; for instance, grapefruits, oranges, lemons, limes, potatoes, spinach, broccoli, pink peppers, and tomatoes. As much as 90% of vitamin C is consumed within the type of greens and fruits. Lack of publicity to those meals has been probably the most frequent explanation for the deficiency. Moreover, vitamin C is heat-sensitive, and traditionally, preparation (boiling or cooking) has eliminated the dietary worth. Whereas a small quantity of vitamin C is discovered inside leukocytes, adrenal glands, or the pituitary, there may be little or no storage of vitamin C within the physique, and due to this fact, plasma focus is essentially associated to latest consumption. Whole physique storage of vitamin C is 1500 mg, and medical options of deficiency happen after that degree is lowered to lower than 350 mg.[5][6][7][8]
Danger elements for Vitamin C deficiency embrace:
Epidemiology
Vitamin C deficiency is outlined as a serum focus of lower than 11.4 umol/L, and prevalence varies internationally, with charges as little as 7.1% in america and as much as 73.9% in north India. Danger elements for deficiency embrace alcohol consumption, tobacco use, low-income, male gender, sufferers on hemodialysis, and people with total poor dietary standing. Though vitamin C deficiency is frequent, even in industrialized international locations, overt scurvy is uncommon. Childish incidence can also be unusual as each breast milk and fortified formulation are an satisfactory supply.
Pathophysiology
Scurvy as a medical manifestation of extreme vitamin C deficiency is attributable to ascorbic acids function in collagen synthesis. Collagen kind IV is the primary constituent of blood vessel partitions, pores and skin, and particularly, the basement membrane zone separating the dermis from the dermis. Vitamin C permits hydroxylation and crosslinking of pro-collagen catalyzed by lysyl hydroxylase. Lack of vitamin C decreases transcription of pro-collagen. Moreover, a scarcity of ascorbic acid results in epigenetic DNA hypermethylation and inhibits the transcription of assorted forms of collagen present in pores and skin, blood vessels, and tissue. Lastly, the important thing function of scurvy is hemorrhage which might happen in virtually any organ. Additional, bone formation is altered and change into brittle.