THE DETECTION OF SUBCLINICAL SCURVY OR VITAMIN C DEFICIENCY

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Abstract
Detn. of the fasting plasma ascorbic acid is the simplest, most direct exploratory method in detection of subclinical vit. C deficiency or scurvy. A simple method for detn. of the degree of tissue depletion is presented. This is based upon the rise in the plasma ascorbic acid following a standard peroral test dose of ascorbic acid (15 mg./kg.). Flat curves reflect severe tissue depletion, medium curves, moderate depletion. 80% of cases with fasting blood plasma levels below 0.1 mg. % showed marked or moderate tissue deficits of ascorbic acid which ranged from 2-5 g. In approximately 80% of cases with fasting plasma ascorbic acid levels below 0.1 mg. %, demonstrable improvement followed adm. of vit. C. Thus, cones, in this range afford strong presumptive evidence of subclinical scurvy. Fasting plasma vit. C values between 0.1 and 0.3 mg. % are probably indicative of significant deficiency in a smaller % of cases, but data in the group are not adequate for judgment. Cases with plasma acsorbic acid levels ranging from 0.3 to 0.8 mg. % show only mild tissue depletion, and it appears unlikely that they are suffering from vit. C de-ficiency- even though the tissues are not saturated. Objective criteria for detection of vit. C deficiency are few. A lowered capillary strength per-se is of little value as an index of such deficiency. However, a lowered capillary strength that is elevated by adm. of ascorbic acid is acceptable evidence of preexisting vit. C deficiency. Mild reticulocyte responses following adm. of vit. C may prove a useful objective index of deficiency. This should be studied further. General symptoms of lassitude, fatigability, anorexia, and rheumatic pains are frequent in the presence of vit. C deficiency. Gingivitis and gingivo-stomatitis occur commonly enough to arouse the suspicion of hypo-vitaminosis C. Vit. C deficiency should be considered as a major or contributory factor in cases of unexplained bleeding. Unpublished observations indicate that vit. C deficiency or subclinical scurvy of the type described is commonly encountered in medical practice.