Severe vitamin C deficiency in a critically ill adult: a case report

Abstract

Scurvy, a severe form of vitamin C deficiency, killed scores of people until its cause and treatment were firmly established at the end of the eighteenth century. Since then, cases have surged periodically around the world, mostly in developing countries and during times of war and famine. In developed countries, scurvy is still endemic and evidence is growing that vitamin C deficiency might affect up to 30 percent of the population. Low socio-economic status, alcoholism, severe psychiatric illness leading to poor nutrition and critical illness are significant risk factors. We hereby report the case of a patient admitted in a Swiss intensive care unit of a tertiary teaching hospital and presenting with clinical signs and symptoms of severe vitamin C deficiency.

The role of vitamin C in the treatment of pain: new insights

“…Children in particular suffer from severe lower limb pain, as evidenced by numerous case reports in the literature [12–16]. There have also been reports of adults and the elderly experiencing musculoskeletal pain due to severe vitamin C deficiency [17, 18]. Scurvy-related pain appears to be primarily due to bleeding into the musculoskeletal tissues, which can become so debilitating that patients are unable to walk [7].…”

“…Those already malnourished are more prone to this development [14]. ” Similarly, others have reported painful scurvy symptoms following confirmed or suspected respiratory infection [18, 19], stating that “sepsis of either digestive or pulmonary origin, leading to sustained metabolic demand, might have acted as a precipitating factor [18]. ” As such, it is possible that other hospital-associated pain may be partly due to vitamin C deficiency, which is relatively prevalent in hospital settings [20–23].…”

“…However, vitamin C deficiency and scurvy has been reported to occur in elderly hospitalized patients [25, 26], critically ill patients [18, 27, 28], and cancer patients [29]. Hospitalized patients, in general, are more likely to present with hypovitaminosis C (defined as plasma vitamin C concentrations <23 µmol/L), and a higher proportion of hospital patients exhibit deficiency compared with the general population [20, 21].…”

Selected aspects of nutrition in palliative care

“…Humans cannot synthesize vitamin C, so it is crucial to delivering it through the diet. Palliative care patients very often face with vitamin C deficiency (plasma vitamin C concentrations < 11 µmol/L) [25] especially because it has been demonstrated that patients under oxidative stress, for example in surgical intensive care, have greater requirements for vitamin C [26]. The administration of anti-cancer drugs may induce a decrease in patients' vitamin C concentrations [27][28][29].…”

Scurvy: A new problem for patients with chronic GVHD involving mucous membranes; an easy problem to resolve

“…Vitamin C deficiency is rare in developed countries; however, in unique clinical situations where intake may be impaired, its associated morbidity and mortality should be taken in consideration. Most of the literature describing vitamin C deficiency is dated ; however, acquired vitamin C deficiency has been reported more recently in several patient populations, including patients with anorexia nervosa, cystic fibrosis, those on long‐term tube feedings, and those with perceived food allergies, among others. In this report, we pose another population to include in this group at increased risk for the development of scurvy.…”