* After 1-3 months, patients develop shortness of breath and bone pain. Myalgias may occur because of reduced carnitine production.
* Other symptoms include skin changes with roughness, easy bruising and petechiae, gum disease, loosening of teeth, poor wound healing, and emotional changes.
* Dry mouth and dry eyes similar to Sj�gren syndrome may occur.
* In the late stages, jaundice, generalized edema, oliguria, neuropathy, fever, and convulsions can be seen.
Physical
* Vital signs: Hypotension may be observed late in the disease. This may be due to an inability of the resistance vessels to constrict in response to adrenergic stimuli.
* Skin: Perifollicular hyperkeratotic papules, perifollicular hemorrhages, purpura, and ecchymoses are seen most commonly on the legs and buttocks where hydrostatic pressure is the greatest. Poor wound healing and breakdown of old scars may be seen.
* Nails: Splinter hemorrhages may occur.
* Head and neck: Gum swelling, friability, bleeding, and infection with loose teeth; mucosal petechiae; scleral icterus (late, probably secondary to hemolysis); and pale conjunctiva are seen.
Conjunctival hemorrhage, flame-shaped hemorrhages, and cotton-wool spots may be seen.
Bleeding into the periorbital area, eyelids, and retrobulbar space also can be seen.
Alopecia may occur secondary to reduced disulfide bonding.
* Chest and cardiovascular: Scorbutic rosary (ie, sternum sinks inward) may occur in children.
High-output heart failure due to anemia can be observed.
Bleeding into the myocardium and pericardial space has been reported.
* Extremities: Fractures, dislocations, and tenderness of bones are common in children.
Bleeding into muscles and joints may be seen. Edema may occur late in the disease.
* Gastrointestinal: Loss of weight secondary to anorexia is common. Upper endoscopy may show submucosal hemorrhage.
Causes
* Scurvy is caused by a dietary deficiency of vitamin C. The body's pool of vitamin C can be depleted in 1-3 months.
* Risk factors include the following: * o Babies who are fed only cow's milk during the first year of life are at risk.
o Alcoholism and conforming to food fads are risk factors.
o Elderly individuals who eat a tea-and-toast diet are at risk. Retired people who live alone and those who eat primarily at fast food restaurants face increased risk of deficiency.
o Economically disadvantaged persons tend to not purchase foods high in vitamin C (eg, green vegetables, citrus fruits), which results in them being at high risk.
o More recently, vitamin C deficiency has been noted in refugees who are dependent on external suppliers for their food and have limited access to fresh fruits and vegetables.
o Cigarette smokers require increased intake of vitamin C because of lower vitamin C absorption and increased catabolism.
o Pregnant and lactating women and those with thyrotoxicosis require increased intake of vitamin C because of increased utilization.
o People with anorexia nervosa or anorexia from other diseases such as AIDS or cancer are at increased risk of vitamin C deficiency.
o People with type 1 diabetes have increased vitamin C requirements, as do those on hemodialysis and peritoneal dialysis.
o Because vitamin C is absorbed in the small intestine, people with disease of the small intestine such as Crohn, Whipple, and celiac disease are at risk.
o Iron overload disorders may lead to renal vitamin C wasting.