Vitamin C plays important roles in the body including in collagen formation, wound healing, and immune function. A deficiency in vitamin C can lead to scurvy, which causes symptoms like bleeding gums, bruising, and poor wound healing. Scurvy develops when vitamin C levels in the body drop below a critical point, which can occur within 1-3 months if dietary intake is lacking. Several groups are at higher risk for vitamin C deficiency, including smokers, pregnant women, and those with digestive disorders that impact absorption. Treatment involves taking supplemental vitamin C orally to restore levels.
Pellagra is a disease caused by low levels of niacin, also known as vitamin B-3. It's marked by dementia, diarrhea, and dermatitis, also known as “the three Ds”. If left untreated, pellagra can be fatal.
There are two types of pellagra, known as primary pellagra and secondary pellagra.
Primary pellagra is caused by diets low in niacin or tryptophan
Secondary pellagra occurs when your body can’t absorb niacin
Pellagra is a disease caused by low levels of niacin, also known as vitamin B-3. It's marked by dementia, diarrhea, and dermatitis, also known as “the three Ds”. If left untreated, pellagra can be fatal.
There are two types of pellagra, known as primary pellagra and secondary pellagra.
Primary pellagra is caused by diets low in niacin or tryptophan
Secondary pellagra occurs when your body can’t absorb niacin
vitamin d is one of the fat soluble vitamin on which there is great emphasis in the present scenario. it is present in breast milk in very minute amount so it is recommended that it must be supplemented right after birth to prevent it deficiency which in children can result in rickets. if not diagnosed and treated in time it may result in number of bony deformities . in adults besides oesteomalacia it is associated with n umber of non communicable diseases.
Vitamin k is a group of lipophilic hydrophobic vitamins. Fat soluble compound necessary for the synthesis of several proteins required for blood clotting.
Occurs in several forms:
Vitamin K1 (Phylloquinone)
Vitamin K2 (Menaquinone)
Vitamin K3 (Menadione) – synthetic form
vitamin d is one of the fat soluble vitamin on which there is great emphasis in the present scenario. it is present in breast milk in very minute amount so it is recommended that it must be supplemented right after birth to prevent it deficiency which in children can result in rickets. if not diagnosed and treated in time it may result in number of bony deformities . in adults besides oesteomalacia it is associated with n umber of non communicable diseases.
Vitamin k is a group of lipophilic hydrophobic vitamins. Fat soluble compound necessary for the synthesis of several proteins required for blood clotting.
Occurs in several forms:
Vitamin K1 (Phylloquinone)
Vitamin K2 (Menaquinone)
Vitamin K3 (Menadione) – synthetic form
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Liposomal vitamin c: Also referred to as L-ascorbic acid, soluble in water (hydrosoluble) and powerful antioxidant. It is essential for tissue repair and growth and collagen synthesis in blood vessels, bones and cartilages.
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Vitamin C deficiency
1. By- Professor (Dr.) Namrata Chhabra
Biochemistry For Medics - Lecture Notes
www.namrata.co
8/30/2014 1
Biochemistry For Medics
2. Vitamin C (ascorbic acid) plays a role in
collagen, carnitine, hormone, and amino acid
formation.
It is essential for wound healing and
facilitates recovery from burns.
Vitamin C is also an antioxidant, supports
immune function, and facilitates the
absorption of iron.
8/30/2014 2
Biochemistry For Medics
3. Scurvy is caused by a dietary deficiency of
vitamin C.
The body's pool of vitamin C can be depleted
in 1-3 months.
Risk factors include the following:
Babies who are fed only cow's milk during the first
year of life are at risk.
Alcoholism
Elderly individuals who eat a tea-and-toast diet
Retired people who live alone and those who eat
primarily fast food
8/30/2014 3
Biochemistry For Medics
4. Economically disadvantaged persons tend to not
purchase foods high in vitamin C (eg, green
vegetables, citrus fruits), which results in them being
at high risk.
Vitamin C deficiency has been noted in refugees who
are dependent on external suppliers for their food and
have limited access to fresh fruits and vegetables.
8/30/2014 4
Biochemistry For Medics
5. Cigarette smokers require increased intake of
vitamin C because of lower vitamin C absorption and
increased catabolism.
Pregnant and lactating women and those with
thyrotoxicosis require increased intake of vitamin C
because of increased utilization.
8/30/2014
Biochemistry For Medics
5
6. People with anorexia nervosa or anorexia from
other diseases such as AIDS or cancer are at
increased risk of vitamin C deficiency.
People with type 1 diabetes have increased vitamin
C requirements, as do those on hemodialysis and
peritoneal dialysis.
Biochemistry For Medics 8/30/2014 6
7. Because vitamin C is absorbed in the small
intestine, people with disease of the small intestine
such as Crohn’s, Whipple, and celiac disease are at
risk.
Iron overload disorders may lead to renal vitamin C
wasting.
Biochemistry For Medics 8/30/2014 7
9. Vitamin C is functionally most relevant for the
triple-helix formation of collagen; a vitamin C
deficiency results in impaired collagen
synthesis.
Proline and lysine hydroxylases are required
for the post synthetic modification of
procollagen to collagen.
Vitamin C is necessary as a coenzyme for
these hydroxylases.
Biochemistry For Medics 8/30/2014 9
11. Formation of intercellular cement substances
in connective tissues, bones, and dentin is
defective, resulting in weakened capillaries
with subsequent hemorrhage and defects in
bone and related structures.
Hemorrhaging is a hallmark feature of scurvy
and can occur in any organ.
Hair follicles are one of the common sites of
cutaneous bleeding
Biochemistry For Medics 8/30/2014 11
12. Bone tissue formation becomes impaired,
which, in children, causes bone lesions and
poor bone growth.
Fibrous tissue forms between the diaphysis
and the epiphysis, and costochondral
junctions enlarge.
Densely calcified fragments of cartilage are
embedded in the fibrous tissue.
Biochemistry For Medics 8/30/2014 12
13. Subperiosteal
hemorrhages,
sometimes
due to small
fractures, may
occur in
children or
adults.
Biochemistry For Medics 8/30/2014 13
14. Early symptoms are malaise
and lethargy.
After 1-3 months, patients
develop shortness of breath
and bone pain.
Myalgias may occur because of
reduced carnitine production.
Other symptoms include skin
changes with roughness, easy
bruising and petechiae, gum
disease, loosening of teeth,
poor wound healing, and
emotional changes.
Biochemistry For Medics 8/30/2014 14
15. Dry mouth and dry eyes
In the late stages, jaundice, generalized
edema, oliguria, neuropathy, fever, and
convulsions can be seen.
Vital signs: Hypotension may be observed
late in the disease. This may be due to an
inability of the resistance vessels to constrict
in response to adrenergic stimuli.
Biochemistry For Medics 8/30/2014 15
16. Skin: Perifollicular
hemorrhages (See
figure),purpura, and
ecchymoses are seen most
commonly on the legs and
buttocks where hydrostatic
pressure is the greatest.
Poor wound healing and
breakdown of old scars may be
seen.
Biochemistry For Medics 8/30/2014 16
18. Head and neck:
Gum swelling, friability, bleeding, and
infection with loose teeth;
mucosal petechiae;
Biochemistry For Medics 8/30/2014 18
19. Scleral icterus (late, probably secondary to
hemolysis); and pale conjunctiva are seen.
Conjunctival hemorrhage,
Bleeding into the periorbital area, eyelids, and
retrobulbar space also can be seen.
Alopecia may occur secondary to reduced
disulfide bonding.
Biochemistry For Medics 8/30/2014 19
21. Chest and
cardiovascular:
Scorbutic rosary (ie,
sternum sinks inward)
may occur in children.
High-output heart failure
due to anemia can be
observed.
Bleeding into the
myocardium and
pericardial space has
been reported.
Biochemistry For Medics 8/30/2014 21
22. Extremities:
Fractures, dislocations, and tenderness of
bones are common in children.
Bleeding into muscles and joints may be
seen.
Edema may occur late in the disease.
Gastrointestinal: Loss of weight secondary
to anorexia is common.
Biochemistry For Medics 8/30/2014 22
23. Diagnosis is usually made clinically in a patient
who has skin or gingival signs and is at risk of
vitamin C deficiency are normal
Laboratory Investigations
A plasma or leukocyte vitamin C level can confirm
clinical diagnosis.
Scurvy occurs at levels generally less than 0.1 mg/dL.
Symptoms occur at levels below 2.5 mg/L, which is
considered deficiency.
Levels of 2.5-5 mg/L indicate depletion.
Levels can be low in patients who have tuberculosis,
rheumatic fever, or other chronic illnesses; those who
smoke cigarettes; and patients on oral contraceptive
drugs.
Biochemistry For Medics 8/30/2014 23
24. Capillary fragility can be checked by inflating a
blood pressure cuff and looking for petechiae on
the forearm.
Bleeding time, clotting time and Prothrombin are
estimated to rule out other bleeding disorders
Biochemistry For Medics 8/30/2014 24
25. An Fe deficiency anemia is generally
observed.
Vitamin C enhances the absorption of iron
from the small intestine.
This may contribute to the anemia seen with
vitamin C deficiency.
Biochemistry For Medics 8/30/2014 25
26. Loss of trabeculae results
in a ground-glass
appearance.
The cortex thins.
A line of calcified,
irregular cartilage (white
line of Fraenkel) may be
visible at the metaphysis.
The epiphysis may be
compressed.
Biochemistry For Medics 8/30/2014 26
27. In adults, scurvy must be differentiated from
Arthritis,
Hemorrhagic disorders,
Gingivitis, and
Protein-energy malnutrition.
Biochemistry For Medics 8/30/2014 27
28. Patients should take ascorbic
acid at 100 mg 3-5 times a
day until total of 4 g is
reached, and then they
should decrease intake to
100 mg daily.
Divided doses are given
because intestinal absorption
is limited to 100 mg at one
time.
Parenteral doses are
necessary in those with
gastrointestinal
malabsorption.
Biochemistry For Medics 8/30/2014 28
29. Diet
Foods high in vitamin C include the following.
Citrus fruits, especially grapefruits and lemons
Vegetables, including broccoli, green peppers,
tomatoes, potatoes, and cabbage
Biochemistry For Medics 8/30/2014 29
30. The recommended daily allowance for vitamin
C varies.
The current recommendation for adults is
120 mg daily, although a dose of 60 mg daily
is all that is required to prevent scurvy.
Diets high in vitamin C have been claimed to
lower the incidence of certain cancers,
particularly esophageal and gastric cancers
Biochemistry For Medics 8/30/2014 30
31. Taking >2 g of vitamin C in a single dose may result
in-
Abdominal pain,
Diarrhea, and nausea.
Since vitamin C may be metabolized to oxalate, it is
feared that chronic, high-dose vitamin C
supplementation could result in an increased
prevalence of kidney stones, thus it is reasonable to
advise patients with a past history of kidney stones to
not take large doses of vitamin C.
There is also an unproven but possible risk that
chronic high doses of vitamin C could promote iron
overload in patients taking supplemental iron.
Biochemistry For Medics 8/30/2014 31
32. Vitamin C deficiency can occur as part of general
under nutrition, but severe deficiency (causing
scurvy) is uncommon.
Symptoms include fatigue, depression, and
connective tissue defects (eg, gingivitis, petechiae,
rash, internal bleeding, impaired wound healing). In
infants and children, bone growth may be impaired.
Severe deficiency results in scurvy, a disorder
characterized by hemorrhagic manifestations and
abnormal osteoid and dentin formation.
Diagnosis is usually clinical.
Treatment consists of oral vitamin C.
Biochemistry For Medics 8/30/2014 32