(Ascorbic acid)

In industrialized countries, a vitamin C deficiency can occur with general malnutrition, but a severe deficiency, which is the cause of scurvy is very rare. Among the deficiency symptoms fatigue, depression and connective tissue damage include (z. B. gingivitis, petechiae, erythema, internal bleeding, delayed wound healing). For infants and babies bone growth is inhibited. The diagnosis is made clinically in general. For the treatment of the lack of vitamin C is administered orally.

Vitamin C plays a role in the formation of collagen, carnitine, hormones and amino acids. It is essential for wound healing and promotes in burn recovery. Vitamin C acts as an antioxidant, strengthens the immune system and helps the absorption of iron (see table: sources, functions and effects of vitamins).

(See also overview of vitamins.) Vitamin C plays a role in the formation of collagen, carnitine, hormones and amino acids. It is essential for wound healing and promotes in burn recovery. Vitamin C acts as an antioxidant, strengthens the immune system and helps the absorption of iron (see table: sources, functions and effects of vitamins). However, vitamin C deficiency (scurvy) In industrialized countries, a Vitamin C deficiency occur in general malnutrition, a serious defect which is the cause of scurvy is very rare. Among the deficiency symptoms fatigue, depression and connective tissue damage include (z. B. gingivitis, petechiae, erythema, internal bleeding, delayed wound healing). For infants and babies bone growth is inhibited. The diagnosis is made clinically in general. For the treatment of the lack of vitamin C is administered orally. A heavy vitamin C deficiency causes scurvy, which is characterized by bleeding and abnormal osteoid and dentin. Etiology In adults creates a primary vitamin C deficiency usually by Inadequate nutrition, the need for vitamin C increases during febrile diseases, inflammatory diseases (especially with diarrhea), achlorhydria, smokers, hyperthyroidism, iron deficiency, cold or heat stress, surgery, burns and protein deficiency. Heat (., By sterilization of food or cooking) destroyed part of the vitamin contained C.Pathophysiologie If there is a lack of vitamin C, the formation of cement substance between the cells in an error in connective tissues, bone and dentin. Consequently, the capillaries are weakened, there is bleeding and defects in bone and bone-like structures. Bone tissue is composed of only limited; in children bone lesions therefore arise, bone growth is inhibited. Between the diaphysis and the epiphysis is fibrotic tissue forms, the cartilage bone boundaries of the ribs expand. Sealing ossified cartilage fragments are incorporated into the fibrotic tissue. Subperiosteal bleeding occur, in part, due to small fractures in children or adults auf.Symptome and complaints In adults, symptoms of vitamin C deficiency develop after months of vitamin C deficiency. Malaise, fatigue, irritability, weight loss, muscle and joint pain can show early already. Symptoms of scurvy (which are associated with connective tissue damage) develop after several months of absence. Follicular hyperkeratosis, curly hair and perifollicular hemorrhages occur. The gums swell and purple, spongy and cracked; in severe deficiency bleeding quickly. Finally, the teeth loosen and fall out. Secondary infections develop. Wounds heal poorly and drench easy spontaneous bleeding form v. a. as ecchymosis in the skin of the lower limbs or as hemorrhages of the bulbar conjunctiva. Other symptoms a femoral neuropathy are due to hemorrhage in femoral tissue wraps, which manifests itself with symptoms similar to a deep vein thrombosis, edema of the lower extremities and painful bleeding and bruising in the joints. In infants, symptoms are irritability, pain during movement, loss of appetite and slower growth. For infants and babies bone growth is inhibited and bleeding and anemia can auftreten.Diagnose Usually based on the clinical findings of skin or gums and risk factors The diagnosis of vitamin C deficiency is usually provided clinically in patients abnormalities of show skin or gingiva and a vitamin C deficiency is likely to. A confirmation by laboratory results is possible. The blood count often shows anemia. Bleeding, coagulation and prothrombin times are normal. X-rays of the skeleton to support the diagnosis of scurvy in children but not in adults. Changes are most evident at the ends of long bones, v. a. at the knee. Early deformations are similar atrophy. By reducing trabecular bone look like frosted glass. The cortex thins out. a white stripe ossified, irregular cartilage is visible at the metaphysis. A thinning or linear fracture proximal and parallel to the white line may be visible only as a triangular defect at the lateral end of the bone, however, is characteristic. The pineal gland is compressed. Healing subperiosteal bleeding lift the periosteum and calcify it. A diagnosis by the laboratory, for a determination of the Blutascorbinsäure is required is sometimes carried out in university hospitals. Values ??of <0.6 mg / dl (<34 mcmol / l) are considered borderline; Values ??of <0.2 mg / dl (<11 mcmol / l) indicate a vitamin C deficiency. A measurement of Ascorbinsäurewerten in the platelet centrifuged blood is not widely available or standardized. In adults, scurvy must differential diagnosis of arthritis, be differentiated from hemorrhagic disease, gingivitis and protein-energy malnutrition. Hyperkeratinisierte, bordered by a hyperemia or hemorrhage hair follicles are almost pathognomonic. Bleeding gums, bleeding into the conjunctiva, most petechiae and ecchymosis are unspezifisch.Therapie Nutritious diet with additional ascorbic adults Skorbutpatienten receive 3 times a day orally 100-500 mg ascorbic acid over 1-2 weeks until the symptoms disappear; then follows a nutrient-rich diet, which provides the 1- to 2-times the amount of the recommended daily dose. The administered to Skorbuttherapie ascorbic acid provides the function of vitamin C within a few days ago again. The symptoms disappear completely after 1-2 weeks. Chronic gingivitis with strong subcutaneous bleeding stays longer bestehen.Prävention a vitamin C dose of 75 mg / day for women and 90 mg / day for men prevents a deficiency. Smokers should also take 35 mg / day. Five servings of fruits and vegetables cover the recommended daily dose of> 200 mg vitamin C.Wichtige points The need for vitamin C is increased in fever, inflammation, diarrhea, smokers, hyperthyroidism, iron deficiency, cold or heat stress, surgery, burns and protein deficiency. After weeks or months of deficiency causes non-specific symptoms (eg. As weakness, fatigue, irritability, joint pain, muscle pain), and later the connective tissue is affected, leading to follicular hyperkeratosis, curly hair, swollen and bleeding gums, loose teeth, poor wound healing leads and spontaneous bleeding. In patients who have skin or gingival symptoms or risk factors for the lack, the ascorbic acid is to be measured. Treatment consists of additional ascorbic acid and a nutritious diet. Vitamin C intoxication The upper intake limit for vitamin C is 2000 mg / day. Up to 10 grams of vitamin C per day, sometimes for – not yet proven – health care consumed in order to prevent, for example, viral infections and shorten sick leave or to slow the progression of diseases such as cancer and atherosclerosis or reverse. Such a high dose acidify the urine, leading to nausea and diarrhea, disturbs the healthy balance of antioxidants and Prooxidanzien and promotes in patients with thalassemia or hemochromatosis, an iron overload. A vitamin C intake below the upper limit of intake affects non-toxic in healthy adults.

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