Osmosis Question of the Week April 8, 2016

April 08, 2016

Answer: C. Regular intake of citrus fruits at breakfast

The patient's history of a diet of bread and water for several months is highly concerning for a nutritional deficiency, particularly of water-soluble vitamins that generally lack substantial stores in the body. Specifically, the findings of perifollicular hemorrhages and ecchymoses point towards vitamin C deficiency, or scurvy. Vitamin C, also known as ascorbic acid, is an antioxidant that facilitates iron absorption by reducing Fe+3 to Fe+2. It is also required for the hydroxylation of proline and lysine during collagen synthesis. Failure of this step results in impaired wound healing and deficits in osteoblast and fibroblast function. As a water-soluble vitamin, deficiency may present within three months of insufficient intake.

The patient's history of a diet of bread and water for several months is highly concerning for a nutritional deficiency, particularly of water-soluble vitamins that generally lack substantial stores in the body. Specifically, the findings of perifollicular hemorrhages and ecchymoses point towards vitamin C deficiency, or scurvy. Vitamin C, also known as ascorbic acid, is an antioxidant that facilitates iron absorption by reducing Fe+3 to Fe+2. It is also required for the hydroxylation of proline and lysine during collagen synthesis. Failure of this step results in impaired wound healing and deficits in osteoblast and fibroblast function. As a water-soluble vitamin, deficiency may present within three months of insufficient intake.

Major Takeaway: Scurvy, which results from a defect in collagen synthesis due to vitamin C deficiency, presents with signs of easy bleeding (perifollicular hemorrhages, petechiae, ecchymoses, hemarthroses), poor wound healing, and anemia.

For more on scurvy, read here.

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