Scurvy

Scurvy (synonym scurvy is a disease caused by the prolonged deficiency in the body of vitamins C and R.
Etiology. Scurvy is developing at an insufficient intake of vitamin C from food or with insufficient its absorption in the gut. The preservation of vitamin C is possible only in the presence of vitamin R Greater role in the development of scurvy are predisposing factors: 1) feed predominantly carbohydrates with insufficient amount of animal protein; 2) infections (acute and chronic), since these increase the demand of ascorbic acid; 3) diseases of the digestive tract, especially of the small intestine; 4) poor conditions of work and life - excessive physical exertion, lack of sleep, lack of light and air, etc.
Pathogenesis. The lack of ascorbic acid in the body is disturbed maturation and regeneration of cells of connective tissue. As a result of changes in the bones and bone marrow. Because at the same time decreases the absorption of iron, can develop hypochromic anemia. Violation of the synthesis of collagen leads to increased fragility of capillaries walls, which explains and peculiar scurvy bleeding. The lack of ascorbic acid in the body have been reduced adrenal function, which leads to muscle weakness, some reduction of metabolism, blood pressure and body resistance.
Pathological anatomy. Typical breakdown of connective tissue with violation of bone growth, disruption of teeth roots with alveolar; degeneration of collagen fibers, the fragility of blood vessels, multiple bleeding of mucous membranes of the oral cavity tonsils, muscles, skin, joints, sometimes in the internal organs.
Marked dystrophy adrenal with the disappearance of stocks of ascorbic acid in them, and other glands of internal secretion, the reserves of glycogen and fat infiltration in the liver cells.
The clinical picture. There are three stages of clinical disease scurvy.
First, hidden) stage, scurvy usually last from one week to several months. At the beginning of the latent stage marked increased skin sensitivity, sensitivity to cold, fatigue, weakness, drowsiness, pain in the legs. Patients pale lips and face several of cyanotic, leather characteristic grey, dirty grey or bronze color, appear petechiae, mainly on the legs.
The second stage will come to the fore hemorrhage. Petechiae are discovered on the body, except the face, palms and feet. Possible clinical manifestations of bleeding internal organs (bloody vomiting, blood in stool, hematuria, and others). Large bleeding in the muscle are accompanied by severe pain, swelling and sharp restriction of movement. Chewing causes pain and bleeding gums.
The third stage is distinguished by the extent and prevalence of hypertension. In the affected areas of skin and mucous membrane ulcers develop, grow phenomenon of gingivitis, the site of the bleeding of the gastrointestinal tract are formed ulcers that may bleed. May occur septic condition. From the side of cardiovascular system are marked palpitations, deafness tone is detected degeneration of myocardium, in some cases significantly reduced blood pressure.
In 20 % of cases the third stage of scurvy is accompanied hypochromic anemia (see), significant limfotsitoz, moderate neutropenia. Indicators of blood coagulation, in bleeding time and the content of prothrombin not changed. Education of bilirubin in the areas of hemorrhage and dystrophic changes in the parenchymal liver can cause mild jaundice. Metabolism characterized by elevated excretion of end products of protein metabolism, the total negative balance of nitrogen metabolism.
Complications: contracture, ankylosis, skin ulceration, bleeding in the cavity (the pericardium, the pleura , and so on), the internal organs, necrosis of the alveolar region of the jaw, the accession of secondary infection.
Prognosis with proper treatment of scurvy is favorable; worsens when complications scurvy infectious diseases, and also in cases if the scurvy combined with tuberculosis, severe pneumonia, dysentery.
Treatment. Introduction of ascorbic acid inside (500-1500 mg) and intravenous (300-600 mg) in combination with vitamin e for 300-450 mg / day inside. It is also shown vitamins: thiamine-bromide (on 50 mg intramuscularly) and Riboflavin (10-30 mg orally). Duration of treatment for about a month. Then dose ascorbic acid is reduced to 200 100 mg per day. The power of the patient during treatment should be varied to include 100-150 g of protein per day, vitamins, calcium. Depleted patients prescribed a blood transfusion 100 ml every 2-3 days, only 4-6 times.
Prevention. Introduction to the diet of plant foods rich in ascorbic acid (tomatoes, green onions, cabbage, horseradish, currant, apples, lemons, oranges). In Northern areas it is advisable to add to the diet vegetable concentrates, extract of dogrose, canned black currant. In their absence it is necessary to recommend the intake of ascorbic acid on the inside of 70 to 80 mg daily, which provides daily need for vitamin C. But even small doses of ascorbic acid (20-25 mg daily) prevent the development of scurvy.


Scurvy (synonym scurvy is a disease caused by prolonged deficiency of vitamin C in the body.
Etiology. The disease is associated with insufficient intake of vitamin C from food or insufficient intake. To preserve vitamin C is obligatory presence of vitamin P. Manifestation of the disease associated with the individual characteristics of the organism, depending on gender, age, functional state of the nervous and digestive systems. So sometimes clinical manifestations may not even at low content of vitamin C in the blood.
Important role in the development of scurvy play predisposing factors: 1) feed predominantly carbohydrates with insufficient amount of animal protein; 2) infections (acute and chronic); they cause a rapid transition of the latent stage of scurvy in explicit, as in any infection, the need for ascorbic acid increases; 3) the pathological condition of the digestive system, especially the small intestine; 4) the nature of the work and the conditions of the environment (excessive physical exertion, lack of sleep, lack of light and air and others).
The pathogenesis of scurvy are not well understood. Understanding of the pathogenic nature of scurvy is based on the participation of ascorbic acid in the formation of collagen and its variants that make up the core intermediate substance of vascular endothelium and reticular connective tissue, cartilage, bone, dentin.
The lack of adequate collagen production, as if cementing the individual cells of the vascular endothelium, creates increased capillary permeability and is the main cause bleeding in scurvy. Currently this is confirmed by electron microscopic studies.
Observed in some patients, a darkening of the skin associated with decreased function of the adrenal glands.
For scurvy happen infringement of oxidative processes, carbohydrate and protein metabolism that is associated with lower redox properties of ascorbic acid.