Vitamin C deficiency

Hypovitaminosis C, aka scurvy, is a condition caused by a dietary lack of vitamin C (ascorbic acid) and is characterized by an increased bleeding tendency and impaired collagen synthesis. It can, also, be caused by reduced absorption of Vitamin C in the gut.

Overview
Despite being considered a rare condition, scurvy still exists nowadays, even in children with no apparent risk factors living in wealthy families. The increasing popularity of dietary restriction for children, especially those with allergies, may potentially enhance the occurrence of scurvy in apparently healthy children.

In hospital patients, it can be highly prevalent, but often unrecognized. Medical awareness of this potentially important disorder is hindered by the inability of most hospital laboratories to determine plasma Vitamin C concentrations. The availability of a simple, reliable method for analyzing plasma vitamin C could increase opportunities for routine plasma vitamin C analysis in clinical medicine.

Symptoms

 * lassitude
 * fatigue
 * irritability
 * poor wound healing
 * gingival (gum) swelling with loss of teeth
 * mucocutaneous petechiae (small red or purple spots caused by bleeding into the skin where the mucosa transitions to skin)
 * ecchymosis (a discoloration of the skin resulting from bleeding underneath, typically caused by bruising)
 * hyperkeratosis (skin condition that occurs when a person's skin becomes thicker)

Evidence
The disease of terminal vitamin C deficiency – Scurvy – is first suspected on clinical grounds. The diagnosis is confirmed by documenting a plasma vitamin C concentration < 11.4 μmol/L and observing prompt clinical improvement after appropriate vitamin C provision. Scurvy is rare in the modern world, but hypovitaminosis C (plasma vitamin C concentration < 28.4 μmol/L ) or marginal vitamin C deficiency (plasma vitamin C concentration < 28.4 μmol/L but > 11.4 μmol/L ) is not. Hypovitaminosis C occurs in  ~ 10% of the general population, in  ~ 30 % of cigarette smokers and  ~ 60% of acutely hospitalized patients, in whom it could contribute to fatigue and mood disturbance, immune system dysfunction, impaired wound healing, the complex regional pain syndrome  and the complications of cardiovascular disease.

Cited from : Subclinical Vitamin C Deficiency: Clinical Application. Six of seven volunteers noted mild but distinct fatigue and/or irritability at depletion, without scurvy. Symptoms disappeared within several days of the 30- or 60-mg daily dose. Although fatigue and irritability have myriad causes, vitamin C deficiency without scurvy should be an additional consideration. Since fatigue and irritability are common symptoms and were so easily reversible, physicians should ask patients with these symptoms about vitamin C ingestion from foods or supplements.

Historical perspective
From a 18th century medical book, Observations of the Scurvy, by Thomas Trotter: "Every person who has been a sea voyage, must have perceived that longing desire for fresh vegetables after being for some time deprived of them. This I have often marked the harbinger of scurvy. Dr Lind, in some part of his work, has mentioned the same circumstances; and he might very justly have put it down as a symptom; for it is more or less an attendant on the disease and not only amuses their waking hours with thoughts of green fields and rivers of pure water but in dreams they are tantalized with the same ideas, and on waking nothing is so mortifying as the disappointment.

When I heard a sailor expressing these desires, and lolling about, I was not surpriced to find him complain of sore gums and a few days after. About this time the colour of the face looks fallow, the eye is dull and heavy, and the whole countenance as it were bloated; the patient feels himself wearied even after sleep, and complains of pains in different parts of the body; he grows inactive, and easily fatigues; often timid; has gloomy ideas about his safety, as if hypochondrical; he flies from duty and wishes to indulge in sloth. To these generally succeed the apperance of the gums which so especially characherizes scurvy; they swell, are spongy and bleed on the slightest cause. The breath is fetid, and often attended with some disagreeable taste of the mouth. ... It is not uncommon for sailors, afflicted with scurvy, to walk upon deck, and drop down irrecoverably; though to all appearance, when below, there seemed no danger; From this I must infer no just prognosis can be always formed.”



Blood test
The blood test procedure for Vitamin C deficiency is highly advanced. A simpler but less accurate is proposed in

Notable studies

 * 1996, Vitamin C pharmacokinetics in healthy volunteers: evidence for a recommended dietary allowance (Full Text)