Harvey's Garden

Vitamin C

2 min read

Epidemiology

Etiology

severe malnutrition (e.g., due to alcoholism, illicit drug use, and/or psychiatric illness)

Pathophysiology

Vitamin C functions

  • Hydrophilic antioxidant
  • Conversion of dopamine to norepinephrine: coenzyme in dopamine β-hydroxylase
  • collagen synthesis: coenzyme in hydroxylation reaction of proline and lysine

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    Vitamin C Deficiency

    Osteogenesis Imperfecta

    Ehlers-Danlos

    Menkes Disease

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  • Facilitates iron absorption (keeps iron in Fe2+ reduced state)

Clinical features

  • Scurvy: clinical manifestation of vitamin C deficiency, which leads to impaired collagen synthesis and easily damaged connective tissue
    • Follicular hyperkeratosis, perifollicular hemorrhage, coiled “corkscrew” hair
    • Intramuscular or subperiosteal hemorrhages, especially in the lower extremities due to increased hydrostatic pressure. This results in pain and difficulty with ambulation, which may be the presenting symptoms in children.
    • Gingivitis, swollen gums
    • Mucosal bleeding, easy bruising, petechiae
    • Impaired wound healing
    • Arthralgia, hemarthrosis
    • Signs of anemia (fatigue, paleness)
      • Normocytic anemia: decreased iron absorption in the small intestine
      • Macrocytic anemia: decreased conversion of folate into its active metabolite
  • Poor immune response

Tip

Suspect scurvy when the patient is malnourished, with symptoms of corkscrew hair, bleeding, anemia.

Diagnostics

Treatment

Vitamin C toxicity

  • Nausea, vomiting
  • Diarrhea, bloating
  • Fatigue
  • ↑ Risk of iron toxicity in transfusion patients and hereditary hemochromatosis due to increased absorption of dietary iron
  • Nephrolithiasis due to ↑ calcium oxalate formation
    • excess oxalate from vitamin C metabolism

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