Vitamin C deficiency

1. Vitamin C deficiency
SCURVY
Prof. Imran Iqbal
Fellowship in Pediatric Neurology (Australia)
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan

2. Al-Quran sura AlRahman 55:8-13

3. Clinical Scenario
• A 12 months old baby girl presented with poor weight gain
and excessive crying.
• Baby took mother feeds for two months and then she was
shifted to top feeds. Now she is taking animal milk feeds and
does not take any solid foods.
• There is frequent history of respiratory infections and
diarrhea

4. Examination
• Her weight is 5.5 kg and length is 67 cm
• On examination, it is noticed that the baby is lying still and
does not show spontaneous movements.
• She cries on handling and touching.
• She has little subcutaneous fat and no significant muscle
mass
• She is pale
• She has swollen gums and sore mouth
• Skin of abdomen is having small petechial spots

5. Functions of Vitamin C
• Synthesis of collagen
• Cholesterol metabolism
• Absorption of Iron
• Anti-oxidant

6. Pathophysiology of Vitamin C deficiency
• Lack of collagen formation in tissues
• Poor osteoid formation and Fragile bones
• Sub-periosteal hemorrhages in long bones
• Weak blood vessel walls with purpura

7. Clinical Features of Vitamin C deficiency
• Irritability and excessive crying
• Musculoskeletal pain and tenderness
• Painful joints
• Swelling of costo-chondral junctions
• Petechial spots and purpura in skin
• Swelling and bleeding of gums
• Poor wound healing

8. Diagnosis
• Clinical presentation
• Radiographic changes are seen in long bones –
• Thin cortex,
• Sclerotic rings around epiphysis,
• Zone of rarefaction at metaphysis,
• Epiphyseal separation

9. Etiology of Vitamin C deficiency
• Sources of Vitamin C – mother milk. citrus fruits,
green vegetables
• Vitamin C is destroyed by cooking and storage
• Daily Requirement = 50 mg
• Vitamin C deficiency can be seen in malnourished
infants having diluted animal milk feeds and cereals

10. Epidemiology of Vitamin C deficiency
• Vitamin C deficiency is rare
• Vitamin C deficiency can occur in children with
severe malnutrition in association with other
deficiencies

11. Treatment of Vitamin C deficiency
• Daily dose of Vitamin C is given
• DOSE : 100 – 200 mg / day
• Given for 3 months

12. Prevention of Vitamin C deficiency
• Mother milk
• Fortified milk farmula
• Variety of semisolid diet
• Multiple micronutrient sachet from 6 months to 5
years of age