Summary
Definition
History and exam
Key diagnostic factors
- vitamin C deficiency upon dietary review
- constitutional symptoms
- easy bruising or bleeding
- gait impairment or leg pain
- pedal edema
- petechial and perifollicular hemorrhages (legs and feet)
- poor wound healing
- bruising and nodular or black ecchymoses at nontraumatic sites
- joint swelling
- oral mucosal petechiae
- coiled hairs
- follicular hyperkeratosis
- tooth loss
- gingival discoloration
- gum swelling
- lid petechiae and hemorrhages
- proptosis
- conjunctival and subconjunctival hemorrhage
Other diagnostic factors
- dysphagia
- alopecia
- sicca-like or Sjogren-like syndrome
- nail clubbing
- peripheral (entrapment) neuropathy
- cerebrovascular accident
- cardiac failure
- hemorrhagic pleural effusion
- osteoporosis
Risk factors
- famine and refugee populations
- acute respiratory distress syndrome
- older people
- living alone
- psychiatric disorders
- alcohol use disorder
- dementia
- low income
- atypical diets
- poor dentition or masticatory inefficiency
- autistic spectrum disorder
- static encephalopathies of childhood
- infants taking only cow's milk
- end stage renal disease, hemodialysis dependence, and/or postrenal transplant
- smoking
- surgery
- sepsis
- HIV
- critical illness
- pancreatitis
- inflammatory bowel disease (IBD)
- graft versus host disease (GVHD)
Diagnostic tests
1st tests to order
- CBC and peripheral blood smear
- serum ascorbic acid
- leukocyte ascorbic acid
- whole blood ascorbic acid
- x-ray of knee and wrist
Tests to consider
- MRI of knee, wrists, and long bones in pediatric cases
- bone marrow biopsy
Treatment algorithm
high risk or symptomatic population
Contributors
Authors
Caleb P. Kitcho, MD
Clinical Assistant Professor of Pediatrics
Senior Pediatric Critical Care Medicine Fellow (PGY-6)
University of Wisconsin School of Medicine and Public Health
Department of Pediatrics
Madison
WI
Disclosures
CK declares that he has no competing interests.
Awni Al-Subu, MD, FAAP
Associate Professor Pediatrics
University of Wisconsin School of Medicine and Public Health
Department of Pediatrics
Madison
WI
Disclosures
AAS has been paid consultancy fees with Edwards Lifesciences and PCCM board review. AAS is a course editor with American Physician Institute.
Acknowledgements
Dr Awni Al-Subu and Dr Caleb P. Kitcho would like to gratefully acknowledge Dr James M. Noble and Dr Marc C. Patterson, previous contributors to this topic.
Disclosures
JMN is an author of two articles cited in this topic. MCP is a member of the scientific advisory boards of the Ara Parseghian Medical Research Foundation, the National Niemann-Pick Disease Foundation, and the Metachromatic Leukodystrophy Foundation. MCP has been a consultant for Actelion, Amicus, IntraBio, Novartis, Orphazyme, Shire, and Vtesse. MCP has undertaken contractual research for Cerecor, Glycomine, Idorsia, and Shire. MCP has stock in IntraBio. MCP has received travel, accommodation or meeting expenses from Actelion, Amicus, Novartis, and Orphazyme.
Peer reviewers
Mark R. Corkins, MD
Professor of Pediatrics
University of Tennessee Health Science Center
Le Bonheur Children’s Hospital
Memphis
TN
Disclosures
MRC declares that he has no competing interests.
Differentials
- Systemic vasculitis
- Hematologic malignancy
- Meningococcemia
More DifferentialsGuidelines
- Nutrition and growth refugee healthy domestic guidance
- 2020-2025 dietary guidelines for Americans
More Guidelines
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