![]() ![]() ![]() Bowing of the long bones, depression of the sternum, and swelling of the costochondral junctions are present on physical examination. Hemorrhage can be intramuscular, intra-articular, or subperiosteal, leading to pain and pseudoparalysis. Musculoskeletal disease frequently presents in children. Additionally, poorly formed soft teeth are prone to infection. Individuals may develop hemorrhagic gingivitis, where the gingiva is initially red, swollen, and shiny and later becomes purple, necrotic, and prone to bleeding. Oral disease is prominent among those with pre-existing poor dentition. Blood vessel wall fragility also results in splinter hemorrhages of the nail bed. This purpura is occasionally palpable, mimicking a cutaneous vasculitis. With time, significant vascular congestion occurs, particularly in the lower extremities, leading to perifollicular hemorrhage and edema. Corkscrew hairs represent fractured and coiled hairs due to impaired keratin cross-links by disulfide bonds. This presentation subsequently generalizes to involve the buttocks, posterior thighs, calves, shins, and back. Phrynoderma, or enlarged hyperkeratotic hair follicles, initially present on the posterolateral arms. The cutaneous manifestations of scurvy include phrynoderma, corkscrew hairs, perifollicular hemorrhage and purpura, edema of the lower extremities, and splinter hemorrhages. They also may experience easy bleeding, bruising, and poor wound healing. Individuals may complain of lethargy, fatigue, malaise, emotional lability, arthralgias, weight loss, anorexia, and diarrhea. Scurvy develops 1 to 3 months after initiating a vitamin C deficient diet. Vitamin C is indicated to prevent and treat scurvy. ![]() Persons at risk for inadequate intake of the vitamin include patients in the following groups: Vitamin C deficiency usually arises in the setting of decreased intake or increased requirements or losses. Consequently, a deficiency in vitamin C results in scurvy, which presents with hemorrhage, hyperkeratosis, and hematological abnormalities. The lack of a stable triple-helical structure compromises the integrity of the skin, mucous membranes, blood vessels, and bone. Proline residues on procollagen require vitamin C for hydroxylation, making it necessary for the triple-helix formation of mature collagen. Although most vitamin C is completely absorbed in the small intestine, the percentage of absorbed vitamin C decreases as intraluminal concentrations increase. Citrus fruits, berries, tomatoes, potatoes, and green leafy vegetables are excellent sources of vitamin C. Humans are unable to synthesize vitamin C, so they can only obtain it through dietary intake of fruits and vegetables. Vitamin C is a water-soluble vitamin, antioxidant, and essential co-factor for collagen biosynthesis, carnitine and catecholamine metabolism, and dietary iron absorption. This activity outlines the indications, mechanism of action, methods of administration, significant adverse effects, contraindications, and monitoring, of vitamin C so providers can direct patient therapy in treatment or supplementation where it is indicated as part of the interprofessional team. Humans are unable to synthesize vitamin C, so it is strictly obtained through the dietary intake of fruits and vegetables. ![]()
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