Vitamin C needs increased by fever, inflammation, diarrhoea, smoking, hyperthyroidism, Fe deficiency, cold or heat stress, surgery, burns, and protein deficiency.
- Always check BNF or equivalent for prescribing advice
- Scurvy is the clinical state from dietary deficiency of vitamin C (ascorbic acid)
- Humans cannot synthesize Ascorbic acid
- Limiting sea voyage, often killing many sailors after two to three months at sea.
- James Lind showed that scurvy could be cured by citrus fruits
- Ascorbic acid was first isolated by Albert Szent-Gyorgyi in 1928
- Vitamin C is an electron donor, or reducing agent
- Antioxidant protection against UV-induced photodamage to skin
- It results in impaired collagen synthesis as it is a co-factor for the proline and lysine hydroxylases that stabilise the collagen molecule tertiary structure
- Vitamin C also promotes collagen gene expression
- Clinical manifestations found in dentine, osteoid and capillary vessel wall tissues
- Apathy, hypochondriasis and depression
- Gum swelling, friability, bleeding, and infection with loose teeth
- Mucosal petechiae; scleral icterus (late, probably secondary to haemolysis);
- Fractures, dislocations, and tenderness of bones are common in children.
- Bleeding into muscles and joints may be seen.
- Perifollicular hyperkeratotic papules, perifollicular haemorrhages
- Purpura, and ecchymoses are the classical skin manifestation of scurvy.
- Osteoarthritis, ageing
- Haemorrhagic disorders and connective tissue/collagen diseases
- Gingivitis, and protein-energy malnutrition
- FBC - may have anaemia
- Not commonly done but Vitamin C levels of < 0.2 mg/dL (< 11 mmol/L) indicate vitamin C deficiency.
- This is primarily a disease
of alcoholics and the elderly who consume <10 mg/d of vitamin C.
- Vitamin C replacement Ascorbic acid 100 to 500 mg po TDS is given for 1 to 2 wk and continued long term
- Five servings of most fruits and vegetables (recommended daily) provide > 200 mg/day of vitamin C.