Vitamin C plasma concentrations around 20 µmol/L result in nonspecific early symptoms, such as decreased physical performance, increased fatigue, and irritability. Persistent undersupply is manifested by increased capillary fragility, decreased resistance to infection, gingivitis, extensive mucosal and skin hemorrhages. Plasma concentrations below 10 µmol/L (0.17 mg/dl) are considered manifest vitamin C deficiency. Clinically manifest vitamin C deficiency diseases include scurvy in adults and Moeller-Barlow disease in children. Both diseases develop insidiously over several months from a state of latent vitamin C deficiency. Clinically manifest scurvy, associated with serum concentrations between 0 mg/l and 2 mg/l, is rare in the industrialized world. An exception is about 5% of the elderly. Early scurvy stage
- Weakness, fatigability
- Poor wound healing as a result of impaired collagen synthesis.
- Increased susceptibility to infections
- Increased capillary fragility, leading to bleeding – hemorrhages – in the skin, among other things
- Bleeding gums
- Mucosal bleeding
- Pain in the more heavily used muscles, especially in the calves
- Skin discoloration (pale yellowish to dirty gray-yellow) after the prodromal stage (about 1-3 months) with the development of fullicular hyperkeratosis – severe keratinization -.
- Punctate – petechial – hemorrhages around the hyperkeratotic changes.
- Hemorrhages into the muscles and under the periosteum in high-strain areas (mainly in the flexor muscles of the lower extremities and in areas that are stretched during exercise, such as the backs of the knees and the area around the Achilles tendons), associated with pulling limb pain – scurvy rheumatism
- In the bedridden, the bleeding is manifested first on the back, buttocks and calves
- Superficial bleeding such as spots – ecchymoses – or streaks – vibices – localize in the vicinity of the shins – the tibia -, on the forearms, and sometimes on the navel
- Bleeding in depth with unchanged skin, resulting in pulling pain with noticeable tenderness of the muscles and bones
- Bone and joint changes result from the progressive hemarthrosis.
The cause of fatigue and weakness in vitamin C deficiency is thought to be a deficit of carnitine, because vitamin C serves as a cofactor in the synthesis of carnitine from lysine into methionine. A deficiency of carnitine has far-reaching consequences for energy production and lipid metabolism, as the amino acid is required for the entry of long-chain fatty acids into the mitochondria, where energy synthesis occurs. Advanced scurvy stage
- Scorbutic ulcers (Rupia scorbutica) due to secondary infections, usually only in the neighborhood of carious teeth, which do not necessarily fall out despite loosening of the mucosa
- Gingivitis (inflammation of the gums)
- Occasional bleeding in conjunctiva – conjunctivae -, choroid and eye chambers, rarely nosebleeds, but is then very difficult to stop
- The skin appears rough, rubbing iron-like – lichen scorbuticus – because the pinhead-sized, brown-red hemorrhages – purpura scorbutica – prefer the hair follicles
- Often the liver is enlarged (hepatomegaly), the spleen almost never.
- Hypotension, vasomotor disturbances, and hypochromic anemia with virtually normal leukocyte and platelet counts; blood clotting and time are unchanged
Psychological changes
- Indifference
- General indisposition
- Slight exhaustibility
- Changes in personality and psychomotor performance.
- Increased melancholy and depression
Moeller-Barlow disease
Infantile scurvy may remain latent for a long period of time before it becomes manifest, for example, during the course of a febrile illness with the following symptoms.
- Large, subperiosteal hematomas, pathologic fractures, often associated with epiphysolysis and severe pain
- “Jumping jack phenomenon” – children flinch at the lightest touch
- Scorbutic gingivitis (occurs only when teeth are already erupted).
In some cases, isolated or repeated hematuria (blood in the urine) is the only symptom. Vitamin C deficiency can lead to growth arrest.In our region, scurvy occurs extremely rarely, since a daily intake of 10 mg of L-ascorbic acid is already sufficient to prevent scurvy. Nowadays, the focus is on subclinical deficiency symptoms, which are very widespread but often not recognized as latent vitamin deficiency symptoms. Subclinical deficiency symptoms include.
- Decreased performance, increased need for sleep, irritability.
- Poor immune system
- Pain in the limbs and joints
