PE12.8 | Vitamin C — Summary & Reflection

KEY TAKEAWAYS

Vitamin C — Key Takeaways:

• RDA: 40 mg/day (infants and children), 65 mg/day (adolescents). Richest Indian sources: amla (~600 mg/100 g), guava (~250 mg/100 g), citrus fruits. All are heat-labile — raw consumption retains maximum content.

• Functions: collagen cross-linking (prolyl/lysyl hydroxylases), non-haem iron absorption (Fe³⁺→Fe²⁺), antioxidant (regenerates vitamin E), neurotransmitter synthesis, immune function.

• Deficiency mechanism in infants: boiled cow's milk destroys 70–90% of the already-low vitamin C content → infants fed exclusively on it develop scurvy by 6–18 months.

• Infantile scurvy (Barlow's disease): extreme irritability, pseudoparalysis, frog-leg posture from subperiosteal haemorrhage. No gum bleeding (no teeth). X-ray: Trümmerfeld zone + Pelkan spurs.

• Scurvy in older children: bleeding gums, perifollicular haemorrhages, corkscrew hairs, poor wound healing.

• Treatment: ascorbic acid 100–300 mg/day orally; improvement in irritability/pain within 48–72 hours.

• Key interaction: vitamin C deficiency compounds iron deficiency anaemia — treat both.

REFLECT

Consider the clinical encounter:

• A mother presents her 10-month-old with inconsolable crying and refusal to move his legs. The orthopaedic registrar suspects osteomyelitis and wants to proceed to bone aspiration. You notice the infant has been on boiled cow's milk since 4 months. What is your next step, and how would you communicate your differential to the team without undermining their authority?

• In India, amla and guava are among the world's richest natural sources of vitamin C and are widely available at low cost. Yet scurvy still occurs. What are the barriers — economic, cultural, or informational — that prevent their regular use in young children's diets, and what role can you play as a physician in addressing these?

• If you were designing a nutrition counselling script for mothers of infants transitioning to complementary feeding at 6 months, what single message about vitamin C would you include, and why?

Write your answers in your reflective log.