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Endocrinology

Insufficiency of ascorbic acid

Insufficiency of ascorbic acid (a hypovitaminosis C) it is caused by its deficit in an organism. Heavy deficit leads it to development of a scurvy.

Epidemiology
The hypovitaminosis With remains the most frequent and significant form of a vitamin deficiency for adults. It can develop at reception of acetylsalicylic acid, estrogen, oral contraceptives, and also at alcoholism, a hyperthyroidism, carrying out a hemodialysis.

Pathogeny
Ascorbic acid plays an important role in oxidation-reduction processes, carbohydrate metabolism, exerts universal impact on permeability of a vascular wall, development and function of bone, cartilaginous tissue, skin, adrenal glands and other bodies. The lack of ascorbic acid leads to oppression of T-system of immunity over time that promotes development of infectious complications.

Classification
Carry the cases which are characterized by moderate weakness, the onychalgia raised by bleeding, scorbutic purpura, an unsharp ulitis to the I stage of a scurvy; working capacity is reduced moderately. In the II stage of a hemorrhage gain widespread character. The hemorrhagic exudate in joints, a pleura is noted. The ulitis and stomatitis are sharply expressed; at patients temperature increases. They need hospitalization. The stage of III is characterized by a serious general condition of patients, sharp emaciation, further increase of bleeding, anemization, developing of long not healing ulcers of extremities, development of infectious complications (pneumonia, tuberculosis, dysentery, sepsis dontogenous, etc.).

Examples of the formulation of the diagnosis:
1. A scurvy of the II stage, hemorrhage to the area of the left gastrocnemius muscle, the expressed ulitis, secondary emaciation.
2. A chronic recurrent coloenteritis in an aggravation phase, a hypovitaminosis About (endogenous).

Preliminary diagnosis, diagnosis
The hypovitaminosis symptomatology With is poor: moderate weakness, fast fatigue, deterioration in appetite, an ache in muscles of legs, bent to odontorrhagias. Gingivas tsianotichna are also loosened. Sometimes reveal a xeroderma, not numerous dot hemorrhages in the field of hair follicles on hands and legs.

Verification of the diagnosis

Especially in the I stage of a disease definition of excretion of ascorbic acid with urine is important.

In II and III stages of a scurvy the clinical symptomatology (an ulitis, stomatitis, dedentition, widespread petekhialny rashes and hemorrhages under skin in muscles, joints, osteoporosis, etc.) in combination with anamnestic data on defective food gives the chance to establish the correct diagnosis.

The differential diagnosis is carried out with hemorrhagic diathesis. At a scurvy there are no essential changes in system of a blood coagulation, as at the majority of these diseases. Massive hemorrhages in muscles and joints, and also a heavy ulitis are not characteristic of a hemorrhagic vasculitis.

Treatment and prevention

The good balanced nutrition, vitamin-rich, and drugs of ascorbic acid are shown. For the purpose of prevention apply ascorbic acid in tablets and a dragee on 0,05 — 0,1 g/days; dogrose infusion, lemons. Widely use polyvitaminic drugs.

Treatment of patients with a scurvy can be carried out to the I stages on an outpatient basis. Appoint ascorbic acid on 0,1 g of 3 — 5 times a day. At the worsened absorption of vitamin C it is entered intramusculary on 1 — 2 ml of 5% of solution. At the same time appoint vitamin P (Rutinum, meletin, etc.) 100 — 150 mg/days.
Patients with II and III stages of a scurvy have to be treated in a hospital. The diet, protein-rich is shown them (to 120 — 150 g/days). At a scurvy of the II stage the daily dose of ascorbic acid has to be not less than 500 mg, at the III stage — 1000 mg, at the same time not less than 1/3 doses should be entered parenterally.

Introduction to a vein of 1 — 2 ml of 5% of solution of ascorbas of sodium together with glucose is effective. Appoint also vitamins P (150 — 300 mg), B1 (20 mg), Riboflavinum (10 mg). Active vitamin therapy spend not less than a month, then doses gradually reduce.

At an ulitis use rinsings of 3% the hydrogen peroxide solution, strong tea, infusions and broths rich with catechins. Gingivas irrigate with freshly cooked aqueous solution of a galaskorbat, Retinolum Solutio oleosa. In programs of rehabilitation use physical methods (Ural federal district, a diathermy, etc.) and physiotherapy exercises (especially for development of function of joints).

 
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