Vitamin C deficiency

Last reviewed: 2 Sep 2023
Last updated: 13 Jan 2020



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
More key diagnostic factors

Other diagnostic factors

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

Risk factors

  • famine and refugee populations
  • 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 and/or hemodialysis dependence
  • smoking
  • surgery
  • sepsis
  • HIV
  • critical illness
  • acute respiratory distress syndrome
  • pancreatitis
  • graft versus host disease (GVHD)
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC and peripheral blood smear
  • serum ascorbic acid
  • leukocyte ascorbic acid
  • whole blood ascorbic acid
  • x-ray of knee and wrist
More 1st investigations to order

Investigations to consider

  • MRI of knee, wrists, and long bones in pediatric cases
  • bone marrow biopsy
More investigations to consider

Treatment algorithm


high risk or symptomatic population



James M. Noble, MD, MS, CPH
James M. Noble

Associate Professor of Neurology

Columbia University Irving Medical Center

Department of Neurology

Taub Institute for Research on Alzheimer’s Disease and the Aging Brain

G.H. Sergievsky Center

Columbia University

New York



JMN is an author of two articles cited in this topic.

Marc C. Patterson, MD
Marc C. Patterson


Division of Child and Adolescent Neurology

Professor of Neurology, Pediatrics, and Medical Genetics


Child Neurology Training Program

Mayo Clinic




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

Sebastian Padayatty, MRCP, PhD


Molecular and Clinical Nutrition Section

Digestive Diseases Branch

National Institute of Diabetes and Digestive and Kidney Diseases




SP declares that he has no competing interests.

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