Vitamin_C_and_its_deficiency_in_Children.pptx

Vitamin C in Children

1. VITAMIN C AND ITS DEFICIENCY IN CHILDREN

2. SOURCES FRESH FRUIT, GREEN LEAFY VEGETABLES Amla is the richest source BREAST MILK (if mother is on adequate diet) 4- 7 mg/100ml FRESH COWS MILK/BUFFALOS MILK 2mg/100ml SPROUTING PULSES

3. Citrus fruits, green peppers, strawberries, tomatoes, broccoli and sweet and white potatoes are all excellent food sources of vitamin C (ascorbic acid)

4. RECOMMENDED DIETARY INTAKE DAILY INTAKE Mg/day Preterm baby 75 0- 6 months 20 6 months- 1 year 40 1 year- adults 40 Pregnancy 40 Lactation 80

5. FUNCTIONS PRODUCTION OF SUPPORTING TISSUE BONE FORMATION (osteoid) TEETH FORMATION (dentin) CAPILLARY FUNCTIONS (collagen )

6. HEMOPOESIS Maturation of R.B.C Transport of iron in the body Helps in conv. Of folic acid to folinic acid and prevent the oxidation of THF

7. ENZYMATIC FUNCTIONS       Imp. Role in oxidation of tyrosine Phenylalanine metabolism Hydroxylation of proline in collagen formation Biogenesis of corticosteroids in adrenals Hydroxylation of aromatic compounds As a cofactor of dopamine B monoxygenase (necessary for nor epinephrine synthesis ) Effect on catecholamine biosynthesis

8. CARBOHYDRATE METABOLISM Impaired glucose tolerence can be corrected by large amount of vit.C FAT METABOLISM Intervention in cholesterol transformation to its principal products of bile acids

9. ANTIOXIDANT EFFECT Important scavenger of free radicles which are derived from oxygen METAL ION METABOLISM  Involved in absorption, mobilization, distribution and intoxication of metal ions Helps in transfer of iron from plasma transferrin into tissue ferritin storage of iron in bone marrow, spleen and liver

10. IMMUNE SYSTEM High doses(1gm/day)- increases IgM and C3 levels May stimulate lymphocyte transformation and mobility of PMN leucocyte BIOSYNTHESIS Neurotransmitters Carnitine

11. SCURVY RARE 6 MONTHS- 2 YEARS

12. ETIOLOGY         Formula and boiled milk fed infants without any vit.C suppl. Breast fed infants of mothers deficient in vit.C Strict macrotic diet Prolonged storage of vit.C containing food products(tin foods) PEM Vit. C dependency Low SE status Increased requirement- burn, fracture, febrile illness, surgery, chronic disorders- ra and tb, pregnancy, lactation, thyrotox., Diarrhea

13. PATHOLOGY SKELETAL CHANGES Significant changes occour at growing end of long bones Failure of ossification Failure of osteoblastic function….Normal balance of productive and destructive processes of bone is altered

14. Process of provisional calcification continues but destruction of cartilage is disturbed Calcified cartilages piles up

15. PERIOSTEUM- Proliferation of fibroblast Loose fibroblastic tissue- hemorrhage can occur easily

16. Zone of weakness between metaphysis and diaphysis Sliping of the diaphysis

17. TEETH Defective collagen formation and chondroitin sulphate Defective dentine formation and loosening of teeth Gums are swollen, red or blue, tender, bleeds on touch

18. ANEMIA Decrease in iron absorption and storage Altered folic acid metabolism Bleeding manifestation

19. HEMORRHAGE Impairment of ability of mesenchymal cells to form normal intracellulars substance- collagen tissue of vascular endothelium Hemorrhage in skin,mm,subperiosteum,into joints ADRENAL FAILURE

20. CLINICAL TYPES Neonatal Latent Infantile Childhood and Adoloscent

21. NEONATAL SCURVY Seen in newborn babies fed on boiled and diluted cows milk Born to mothers with vit c def Fever,crying,swelling of knee joint X RAY- ringed epiphysis

22. LATENT SCURVY Low plasma ascorbic acid level but no classical manifeatstions like bony changes Anorexia,wkness, FTT, irritability,restlessness,freq.RTI, Diagnosis- history, blood vit.C level X- ray- nonspecific bone atrophy

23. INFANTILE SCURVY  PSEUDOPARALYSIS  SCORBUTIC ROSARY

24. LOOSE TETH RED, SPONGY SWOLLEN AND BLEEDING GUMS

25.  HEMORRHAGE BONE- SUBPERIOSTEAL SKIN- PETECHIE ECHYMOSIS RENAL-HEMATURIA GIT- MALENA EYE- RETRORBITAL CNS- INTRACRANIAL

26. ANEMIA RECURRENT RTI DELAYED WOUND HEALING

27. CHILDHOOD AND ADOLESCENT SCURVY BLEEDING MANIFESTATIONS ARE MORE COMMON( infantile scurvy- more skeletal manifestations)  Follicular hyperkeratosis and minute perifoolicular hemorrhage at the root of hair follicles around the big joints ( A SIGN OF ADVANCED DEF.) After 1-3 months of onset- Dyspnea, bone pain and joint pain (subperiosteal hge)

28. Advanced cases- ecchymoses and purpura may develop initially at areas of trauma and irritation or in the muscles and subcutaneous tissues Joint effusion and hemorrhage Splinter hge of nail bed Emotional disturbances Hairs- fragmented and burried

29. Extereme depletion state        Dyspnea Edema Icterus Oliguria Neuropathy Convulsion Hypotension Death

30. RADIOLOGICAL CHANGES EARLY SIGNS Ground glass appearance Thinning of cortex Epiphyseal rarefaction and seperation Provisional zone of calcification

31. ADVANCED SIGNS      Spur formation Scurvy line Tremerfield zone Corners sign Subperiosteal hemorrhage Fracture in prov. Zone of calcification or metaphyseal fractutres

32. LABORATORY DIAGNOSIS BLOOD     HB% ANEMIA TYPING (normocytic normochromic /microcytic hypochromia/megaloblastic) WBC COUNT (raised- infections) SERUM BILIRUBIN PT

33. FASTING SERUM ASCORBIC ACID LEVEL     >0.6mg/dl- rules out scurvy >0.2 normal 0.1- .19 low value <0.1 sugestive of scurvy

34. PLASMA ASCORBIC ACID LEVEL   0.7 mg- 1.2mg/dl –normal 0.4- 0.7 – mild deficiency <0.4 – severe deficiency Plasma and serum conc. Respond to changes in dietary vitamin c concentration- used for assesment of recent vit.c intake Poor indicators of tissue levels

35. ESTIMATION OF VITAMIN C WHITE CELL PLATELET LAYER Leucocute concentration of vitamin c is a better indicator of body store ≤10µg/10 8 WBC - Deficient TISSUE SATURATION TEST 10mg/kg ascorb. Acid given orally First 24 hrs- 80% excreted normally in urine 0- 20% severe deficiency

36. VITAMIN C TOLERANCE TEST I V ascorbic acid 20mg/kg given in NS 4 hr URINE SAMPLE- urinary excretion of vit c > 1.5 mg/dl- scurvy excluded

37. COMPLICATIONS Repeated acute RTI Adrenal failure Haematomyelia SUBDURAL HAEMATOMA (rare) LIMB SHORTENING AND KNEE FLEXION CONTRACTURES (rare)

38. TREATMENT   LATENT SCURVY- VIT.C 100- 200mg/day VIT.C RICH DIET CLINICAL SCURVY- ASCORBIC ACID 500- 1000mg loading dose- repeated daily for 1 week (I V route in diarrhea, adrenal failure,shock) Maintainance dose of vitamin c 50- 75 mg/day

39. DIET- containing fruit, green vegetables, fresh orange juice, tomato juice

40. SIGNS OF IMPROVEMENT       Within 48 hrs- pain, tenderness, apprehensive facies improves 3- 5 days- bleeding gums stop, tenderness of bone disappears, serum bili becomes normal 10- 12 days- ecchymosis and haematoma disappear weeks- radiological response weeks- swelling of bone( may persist more) 1 month- pigmentary changes of hemorrhage