Scurvy: From a Selective Diet in Children with Developmental Delay

Seya, Megumi; Handa, Atsuhiko; Hasegawa, Daisuke; Matsui, Toshihiro; Nozaki, Taiki

doi:10.1016/j.jpeds.2016.06.018

Cited by 16 publications

(9 citation statements)

References 5 publications

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“…Neurological disorders, autism, iron overload due to multiple transfusions, chemotherapy, bone marrow transplant and hemodialysis are considered the main predisposing conditions in modern age ( 1 , 2 ). The diagnosis is often misleading, since other morbidities as malignancies, coagulopathies, septic arthritis, osteomyelitis or rheumatologic disorders are often considered at first ( 3 – 5 ). We report the case of an otherwise healthy child who developed scurvy as consequence of strictly selective diet; the patient underwent extensive and invasive examinations before the correct diagnosis was considered.…”

Section: Introductionmentioning

confidence: 99%

Pediatric Scurvy: When Contemporary Eating Habits Bring Back the Past

et al. 2018

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Vitamin C deficiency is anecdotal in developed countries, mainly associated with underling clinical morbidities as autism or neurological impairment. Chronic insufficient dietary supply is responsible for vascular fragility and impaired bone formation, resulting in gingival bleeding, petechial lesions, articular and bone pain or limb swelling. Children may present anorexia, irritability, failure to thrive, limping or refusal to walk. Accordingly, pediatric scurvy is frequently misdiagnosed with osteomyelitis, septic arthritis, bone and soft tissue tumor, leukemia, bleeding disorders, and rheumatologic conditions. We report the case of a 3-years old child developing scurvy as consequence of strict selective diet; extensive and invasive investigations were undertaken before the correct diagnosis was considered. Despite being considered a rare condition, scurvy still exists nowadays, even in children with no apparent risk factors living in wealthy families. The increasing popularity of dietary restriction for children, especially those with allergies, may potentially enhance the occurrence of scurvy in apparently healthy children. Appropriate dietary anamnesis is fundamental in order to highlight potential nutritional deficit and to avoid unnecessary invasive diagnostic procedures. Patients without considerable risk factors may benefit from psychological support in order to investigate possible eating disorders.

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Section: Introductionmentioning

confidence: 99%

Pediatric Scurvy: When Contemporary Eating Habits Bring Back the Past

et al. 2018

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“…Although micronutrient deficiencies and malnutrition are still considered rare in industrialised countries, pathological restrictive feeding patterns have re‐established it as an entity of modern medicine . As defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, ARFID is an eating or feeding disturbance due to the sensory characteristics of food or consequences thereof, with evidence of persistent failure to meet appropriate nutritional needs.…”

Section: Discussionmentioning

confidence: 99%

Three‐year‐old girl with progressive leg pain, weakness and refusal to ambulate

Gallagher

Mangalick

Bradshaw

et al. 2019

J Paediatrics Child Health

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“…Vitamin C deficiency remains a clinical problem in contemporary health care. The deficiency has been reported in children with neurological and behavioral disabilities, cohorts with stringent dietary restrictions, patients with chronic health disorders, the elderly, and renal disease patients (9)(10)(11)(12). Numerous case reports have described costly and preventable delays in diagnosis, which could have been avoided had a vitamin C measurement been promptly obtained (1)(2)(3)(4).…”

Section: Discussionmentioning

confidence: 99%

A Simplified Sample Preparation Method for the Assessment of Plasma Ascorbic Acid in Clinical Settings

Yu-guan

Becker

Brown

et al. 2018

The Journal of Applied Laboratory Medicine

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Background: Vitamin C deficiency is difficult to diagnose on the basis of clinical presentation alone and requires plasma levels for confirmation. Reference laboratories typically specify shipment of plasma on dry ice. This requirement may complicate clinic work flow and delay vitamin C measurement. Additionally, patients with vitamin C deficiency may experience unnecessary testing and increased health-care costs, as other diagnoses are often considered first. We examined an alternative, more practical shipping method. Methods: Plasma was collected from 17 healthy volunteers by use of heparin tubes with gel separators, and all tubes were centrifuged immediately to separate the plasma layer from the cells. Baseline vitamin C was measured in plasma obtained immediately after specimen collection. Remaining sample tubes were held in Styrofoam containers with cold packs for 30 h or 48 h, followed by vitamin C measurement. Additional samples were exposed to conditions that simulated harsher shipping conditions. Results: Mean plasma vitamin C was 69.6 μmol/L (SD = 21.5 μmol/L). Vitamin C losses were 5.4% at 30 h (SD = 5.55%, P < 0.05) and 7.6% at 48 h (SD = 5.56%, P < 0.05), which is slightly more than freeze-and-thaw treatment (average loss of 1.4%, SD = 6.9%, NS). The vitamin C method had an intraday variation of 1.88%. Vigorous shaking of 2 samples for 24 h resulted in a −1.9% change in 1 sample, and a +4.1% change in another sample. Exposure of the shipping container to elevated temperature (35°C for 30 h) did not change the internal temperature of the container. Conclusions: The shipping procedure uses routine sample handling, standard vacutainers, and can be replicated by health-care centers seeking to evaluate patient vitamin C status. IMPACT STATEMENT These study findings will benefit patients with scurvy, as diagnosis has been delayed because of the challenges in sending plasma samples to a reference laboratory for vitamin C measurement. Geriatric and renal-disease patients may also benefit from plasma vitamin C assessment. There has been uncertainty about vitamin C stability, which has led to emphasis on immediate freezing of plasma. This manuscript contributes to knowledge on stability under conditions that replicate routine plasma sampling procedures. The evidence in this manuscript establishes that vitamin C in heparinized plasma is stable for 30-48 h, when maintained within a shipping container with an internal temperature of 0.1°C.

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Scurvy: From a Selective Diet in Children with Developmental Delay

Cited by 16 publications

References 5 publications

Pediatric Scurvy: When Contemporary Eating Habits Bring Back the Past

Pediatric Scurvy: When Contemporary Eating Habits Bring Back the Past

Three‐year‐old girl with progressive leg pain, weakness and refusal to ambulate

A Simplified Sample Preparation Method for the Assessment of Plasma Ascorbic Acid in Clinical Settings

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