- Vitamin C deficiency, also known as scurvy, was historically common among sailors until James Lind discovered that oranges and lemons could cure scurvy in 1757. - Studies in India have found vitamin C deficiency rates between 1-59% depending on the population, with those living in poverty or with digestive disorders at highest risk. - Symptoms of scurvy include bleeding gums, bruising, and bone pain. It is diagnosed through blood tests and treated with vitamin C supplementation.

1. MICRONUTRIENTS IN HEALTH AND
DISEASE: Vitamin C
- D. Vighnesh
(4th Year MBBS, VMC KNL)

2. OVERVIEW
● In 1747, James Lind conducted a trial of
six different treatments for 12 sailors
with scurvy: only oranges and lemons
were effective in treating scurvy.
● In 1928, Albert Szent-Györgyi isolated a
substance from adrenal glands that he
called 'hexuronic acid'. Four years later,
Charles Glen King isolated vitamin C in
his laboratory and concluded that it was
the same as 'hexuronic acid'.
● Many animals, unlike humans, can
synthesize their own vitamin C.

3. BURDEN OF SCURVY
IN INDIA
Sporadic studies in the country have
indicated the prevalence of vitamin C
deficiency varying widely between 1.1%
among malnourished children. A study
carried out in children 6-16 years in
Hyderabad indicated 59.6% had poor
vitamin C status (<30 µmol/L).
Prevalence of vitamin C deficiency (<2
µg/mL) was reported to be highest
among Indians and people of South
Asian origin compared to other races,
except the Mexican population.

4. RECOMMENDED DIETARY ALLOWANCE OF Vit.C
LIFE STAGE UPPER LIMIT
Birth to 12 months Not established
Children 1–3 years 400 mg
Children 4–8 years 650 mg
Children 9–13 years 1,200 mg
Teens 14–18 years 1,800 mg
Adults 2,000 mg

5. DIETARY SOURCES OF VITAMIN C

6. ROLES OF VITAMIN C IN HOMEOSTASIS
There are several functions of Vitamin
C. Some of them are as follows:
● Boosting immune system
● Maintenance of epithelium
● Maintenance of capillaries
● Maintenance of bones and
cartilages
● Wound healing
And so on

7. RISK FACTORS FOR VITAMIN C DEFICIENCY
Risk factors for Vitamin C deficiency include:
● Babies only fed cow's milk
● Poor people who are not able to afford fruits and vegetables
● Individuals with eating disorders
● Type 1 diabetes who have high vitamin C requirements
● Individuals with disorders of the GI tract like inflammatory bowel disease.
● Individuals with iron overload which leads to wasting of vitamin C by the
kidneys
● Individuals with restrictive diets, food allergies

8. CLINICAL FEATURES OF VITAMIN C
DEFICIENCY

9. DIAGNOSIS OF SCURVY
Scurvy is mainly diagnosed by the following methods:
● Clear and meticulous history taking from the mother.
● Thorough clinical examination, which usually reveals four H: Hemorrhagic signs,
Hyperkeratosis, Hematological abnormalities and Hypochondriasis.
● A low plasma level of vitamin C (plasma ascorbate concentration of <0.2 mg/dl usually is
considered deficient) is specific in scurvy.
● Leukocyte concentrations of less than or equal to 10 μg/108 WBCs are considered
deficient and indicate latent scurvy
● Another indicator of vitamin C body stores is its measure of urinary excretion after
parenteral ascorbic acid infusion. After 100 mg of an intravenous dose of vitamin C, 80%
should be excreted within 5 h if the body stores are not deficient

10. MANAGEMENT OF SCURVY
Infants and children are usually treated with vitamin C 100–300 mg daily and adults 500–1000 mg daily for
1 month or until full recovery of clinical signs and symptoms occurs. Spontaneous bleeding as well as oral
and constitutional symptoms are the foremost to recover (in days) while bone abnormalities and ecchymoses
resolution take longer (in weeks). Along with vitamin C therapy, symptomatic treatment should also be given
in the form of analgesics and rest to the part through splintage. There is no role of antibiotics in the
management of such patients.
Separation of the epiphysis from the metaphysis is always through the zone of provisional calcification, the
weak zone. With occurrence of this fracture, periosteum stripping occurs with collection of subperiosteal
hematoma. Following nutritional supplementation vitamin C, this subperiosteal hematoma quickly calcifies.
Two phenomenon occur: new bone is laid beneath the elevated periosteal sleeve and the underlying
protruding shaft undergoes rapid resorption and get aligned with long axis of bone. After subperiosteal bone
formation, the epiphysis becomes centered on the widened metaphyses. Separation of the epiphysis in scurvy
is best treated conservatively by splintage and vitamin C supplementation and a closed or open surgical
reduction of the displaced epiphysis is rarely required. Complete remodeling follows in a child and residual
deformity or growth disturbance are seldom reported.

11. CLINICAL FEATURES

12. HYPERVITAMINOSIS C
For adults, the recommended daily amount
for vitamin C is 65 to 90 milligrams (mg) a
day, and the upper limit is 2,000 mg a day.
Although too much dietary vitamin C is
unlikely to be harmful, megadoses of
vitamin C supplements might cause:
● Diarrhea
● Nausea
● Vomiting
● Heartburn
● Abdominal cramps
● Headache
● Insomnia

13. RECOMMENDATIONS FROM LEADING
INSTITUTES OF INDIA
National Institute of Nutrition (NIN) suggests that:
Rich fruits like gooseberries (Amla), guava and citrus should be encouraged to consume.
Infants fed animal milk should receive supplements of iron and vitamin C
Vitamin C rich foods must be consumed daily to improve iron absorption.
The committee has evaluated all the available evidence on this subject and estimated the EAR
and RDA based on replacement levels of body pool saturation of 900 mg, for a metabolic loss of
2.9% per day, compensated for the urinary loss (25% per day), taking absorption efficiency in
Indian foods also into consideration. The EAR was set at 65 mg per day and RDA at 80 mg per
day for adult males. Due importance of ascorbic acid in a meal to improve iron absorption
among Indians on a vegetarian diet is also emphasized while making the recommendations.

14. THANK YOU
References:
1. https://www.ncbi.nlm.nih.gov/books/NBK4
93187/
2. https://www.indianpediatrics.net/nov2014/n
ov-932-933.htm
3. https://www.mdpi.com/2072-
6643/12/7/2008
4. https://www.nhs.uk/conditions/vitamins-
and-minerals/vitamin-c/
5. https://www.researchgate.net/publication/3
25548001_Vitamin_C_Should_we_supple
ment
6. https://www.nin.res.in/nutrition2020/RDA_
short_report.pdf
7. https://www.ijpd.in/article.asp?issn=2319-
7250;year=2021;volume=22;issue=2;spage
=118;epage=122;aulast=Kaur
8. Scurvy in pediatric age group - A disease
often forgotten? :
https://europepmc.org/article/pmc/44113
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