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Vitamin C deficiency

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 20 Aug 2025
Last updated: 08 Nov 2024

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
Full details

Other diagnostic factors

  • dysphagia
  • alopecia
  • sicca-like or Sjogren-like syndrome
  • nail clubbing
  • peripheral (entrapment) neuropathy
  • cerebrovascular accident
  • cardiac failure
  • hemorrhagic pleural effusion
  • osteoporosis
Full details

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)
Full details

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
Full details

Tests to consider

  • MRI of knee, wrists, and long bones in pediatric cases
  • bone marrow biopsy
Full details

Treatment algorithm

INITIAL

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.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Centers for Disease Control and Prevention. Nutrition and growth: refugee health domestic guidance. May 2024 [internet publication].Full text

Dietary Guidelines for Americans. 2020-2025 dietary guidelines for Americans. Dec 2020 [internet publication].Full text

Gonzalez-Campoy JM, St Jeor ST, Castorino K, et al. Clinical practice guidelines for healthy eating for the prevention and treatment of metabolic and endocrine diseases in adults: cosponsored by the American Association of Clinical Endocrinologists/the American College of Endocrinology and the Obesity Society. Endocr Pract. 2013 Sep-Oct;19 Suppl 3:1-82.Full text

Panel on Dietary Antioxidants and Related Compounds, Subcommittees on Upper Reference Levels of Nutrients and Interpretation and Uses of DRIs, Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board, Institute of Medicine. Chapter 5: vitamin C. In: Food and Nutrition Board, Institute of Medicine’s Dietary reference intakes for vitamin C, vitamin E, selenium, and carotenoids. Washington DC: National Academy Press; 2000: 95-185.Full text  Abstract

National Institutes of Health. Vitamin C: fact sheet for health professionals. Mar 2021 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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