| ID | 374 |
|---|---|
| Name | INFANTILE SCURVEY |
| Cause | Vitamin C deficiency. |
| Signs Symptoms | Irritability. Pain when they move. No appetite. Failure to gain weight. Anemia. |
| Diagnosis | The diagnosis of scurvy is mainly based on clinical presentation, plain radiograph findings of long bones and related history of poor intake of vitamin C, |
| Investigations | Investigations: The diagnosis of Scurvey is usually based on radiological changes in the long bones, especially at their distal ends. X-ray of long bones (knee joint) findings- - bone appears osteopenic or “ground-glass” appearence. - Cortex reduced to “pencil-point thinness.” - metaphysitis - white line of frenkel, which represents the zones of well calcified cartilage at the metaphysis. - corners sign. - epiphyseal ring. - may be sign of periosteal reaction- shadow of periosteum & soft tissue swelling. |
| Management | Infants and children are usually treated with vitamin C 100–300 mg daily and adults 500–1000 mg daily for 1 month or until full recovery of clinical signs and symptoms occur |
| Introduction | Scurvey is a clinical condition develops due to deficiency of vita-C & characterized by weakness, ulceration of gum & hemorrhage in the skin & subcutaneous tissue & bony changes. Scurvey may occur at any age but extremely rare in the newborn infant. The majority of cases occur in infants 6-24 months of age. |
| History | |
| Etiology | see under causes |
| Clinical Features | Clinical feature: The main clinical features are lassitude, irritability, anemia loss of appetite, digestive disturbances, painful limbs & enlargement of the costochondral junctions. There may be a ‘rosary’ at the costochondral junctions & a depression of the sternum. The angulation of the ‘scorbutic beads’ is usually sharper than that of the rachitic rosary. There may be subperiosteal hemorrhage in one of the long bones which gives rise to intense pain, this results in pseudoparalysis of the limbs & the legs assume the typical ‘frog position’. Petechial hemorrhage may occur in the skin mucus membrane. Occasionally hematuria or malena may occur. |
| Preventions | Prevention: 1. Scurvey is prevented by a diet rich in vitamin C: citreous fruits (e.g. guava, amloki, tomato, orange etc) and green vegetables are excellent sources. 2. Formula fed infants should be supplied with 35mg of ascorbic acid daily, Cow’s milk contains only about a quarter of vitamin C content of human milk and this is further destroyed by boiling, i. Breast feeding should be encouraged, ii. Lactating mothers should have a daily intake of 100 mg of vitamin-C. |
| Treatment | Treatment: 1. Rapid recovery can be obtained with oral ascorbic acid, 200mg per day. There is no advantage in parenteral administration. The administration of 3-4 ounces of tomato juice or orange juice daily will quickly produce healing; despite ascorbic acid treatment is preferable. 2. After scurvy has been cured (assessed clinically and radiologically), the normal requirement of vitamin C (35-50mg per day) should be given in the form of drug or diet. |
| Complications | Children may experience anemia, high blood pressure, problems with wound healing, and failure to thrive. In infants, untreated deficiency can lead to pseudoparalysis, which is a lack of muscle power, and older children may refuse to walk |
| Prognosis | Prognosis: Appropriate diagnosis & treatment recovers the patient rapidly but swelling of subperiosteal hemo-rrhage may require months to disappear. Body growth usually quickly resumed.” Very rarely, a patient with scurvy may die suddenly from cardiac failure. |
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