Vitamin C is an essential water-soluble nutrient that functions as an antioxidant. It is required in the diet since humans cannot produce it internally. Vitamin C deficiency can result in scurvy, with symptoms of bleeding gums, slow wound healing, and bone pain. Cooking, storage, and processing can reduce vitamin C content in foods. Good dietary sources include amla, guava, and citrus fruits. The recommended daily intake is 40 mg for adults.

1. VITAMIN C
DR.HARIVANSH CHOPRA
M.D.,DCH
PROFESSOR& EX.HOD
DEPT.OF COMMUNITY MEDICINE
L.L.R.M.MEDICAL COLLEGE,MEERUT
harichop@gmail.com

2. OBJECTIVES
1) What is Vitamin C,
its functions, rich
sources and its daily
requirement?

3. OBJECTIVES
2. What are the
diagnostic
features of
deficiency and its
management?

4. HISTORY
 As early as the 1700's,
vitamin C was referred to
as the "antiscorbutic
factor," since it helped
prevent the disease called
scurvy.

5. HISTORY
 This disease was first
discovered in British
sailors, whose sea
voyages left them far away
from natural surroundings
for long periods of time.

6. HISTORY
 Their body stores of
vitamin C fell below 300
milligrams, and their gums
and skin lost the protective
effects of vitamin C.

7. HISTORY
 Recognizing limes as a
good shipboard source of
vitamin C, the British
sailors became known as
"limeys" for carrying large
stores of limes aboard
ship.

8. What is vitamin C?
 Vitamin C, also called Ascorbic acid, is a
water-soluble nutrient that is easily
excreted from the body when not
needed.

9. What is vitamin C?
 It's so critical to
living creatures
that almost all
mammals can use
their own cells to
make it.

10. What is vitamin C?
 Humans, gorillas,
chimps, bats, guinea
pigs and birds are some
of the few animals that
cannot make vitamin C
inside of their own
bodies.

11. What is vitamin C?
Humans vary greatly
in their vitamin C
requirement, and the
amount of vitamin C
found in food varies
as dramatically as our
human requirement.

12. How it Functions?
 Vitamin C serves a predominantly
protective role in the body.
 The protective role of vitamin C goes far
beyond our skin and gums.

13. How it Functions?
Cardiovascular diseases,
Cancers,
Joint diseases and
Cataracts ….are all associated with
vitamin C deficiency

14. How it Functions?
 Vitamin C
achieves much of
its protective effect
by functioning as
an antioxidant and
preventing oxygen-
based damage to
cells.

15. How it Functions?
 Structures that
contain fat are
particularly
dependent on
vitamin C for
protection.

16. Food Sources (Fruits)
1.Amla - 600mgm/ 100gm
2.Guava-212mgm/100gm
3.Lemons -63mgm/100gm
4.Orange – 30mgm/100gm

17. Food Sources(Vegetables/100GM)
1.Cabbage -124mgm
2.Amaranth- 99mgm
3.Cauliflower -56mgm

18. Food Sources
Mustard,
Papaya,
Grapefruit

19. Impact of Cooking,
Storage and Processing
 How do cooking, storage, or processing
affect vitamin C?
 Vitamin C is highly sensitive to air, water, and
temperature.
 About 25% of the vit. C in vegetables can be
lost simply by boiling or steaming the food for a
few minutes).

20. Impact of Cooking,
Storage and Processing
 This same degree of loss occurs in freezing and
unthawing of vegetables and fruits.
 Cooking of vegetables and fruits for longer
periods of time (10-20 minutes) can result in a
loss of over one half the total vitamin C
content.

21. Impact of Cooking,
Storage and Processing
 When fruits and vegetables are canned and
then reheated, only 1/3 of the original vitamin
C content may be left.
 Consumption of vitamin C-rich foods in
their fresh, raw form is the best way to
maximize vitamin C intake.

22. Public Health Recommendations
 REQUIREMENTS:-
1) TERM INFANTS: 25mg/day
2) PREMATURE BABIES: 50mg/day
3) OLDER CHILDREN & ADULTS:40mg/day
4) LACTATION : 80mg/day
5) PREGNANCY 60Mg/day

23. Drug-Nutrient Interactions
 Categories of drugs that can
diminish the body's supply
of vitamin C include :
1. Oral contraceptives,
2. NSAIDs
3. Corticosteroids,
4. Sulfa drugs and,
5. Barbituates.

24. Nutrient Interactions
 Conversely, vitamin
C can significantly
enhance iron
uptake and
metabolism, even
at food-level
amounts.

25. Nutrient Interactions
 Vitamin C also has
important interactions
with other vitamins.
 Excessive intake of
vitamin A, for eg., is
less toxic to the body
when vitamin C is
readily available.

26. Nutrient Interactions
 Vitamin C is involved
in the regeneration of
vitamin E, and these
two vitamins appear
to work together as
t h e a n t i o x i d a n t s

27. Health Conditions
 What health conditions require special
emphasis on vitamin C?
1. Acne
2. Alcoholism
3. Alzheimer's disease
4. Asthma

28. Health Conditions
5. Autism
6. Depression
7. Diabetes
8. Irritable bowel disease
9. Parkinson's disease

29. Clinical Features
 What are the clinical
features of vitamin C
deficiency?
1) Scurvy, i.e. bleeding gums
2) Slow wound healing,
3) Anemia,

30. Clinical Features
4) Tender bones and infant
is reluctant to move his
limbs which are kept in
frog like position
(pseudoparalysis)
5) Shortness of breath
6) Fatigue,

31. Clinical Features
7) Easy bruising.
8) Nose bleeds.
9) Frequent
infections.
10) increased risk for
various cancers,

32. Clinical Features
11) impaired formation and
maintenance of collagen
resulting in “scorbutic
rosary”.
12) Impaired multiple
hormonal functions,
13) Dermatitis,

33. Clinical Features
14) Petechial haemorrhages
are often present in skin
and mucous membranes.
15) Hematuria
16) Malena
17) Orbital & subdural
haemorrhage may also
occur.

34. Clinical Features
18) arthritis,
19) chronic gingivitis,
20) reduced insulin
production,
21) some types of male
infertility.

35. DIFFERENTIAL DIAGNOSIS
 Other causes of Pseudoparalysis viz. :
1. Septic arthritis
2. Osteomyelitis
3. Congenital syphilis
4. Pseudoparalysis maybe confused with
polio.

36. DIAGNOSIS
 Diagnosis is based on
Radiological features
mainly seen at the lower
end of femur and upper end
of humerus and tibia.
 Bone assumes a ground
glass appearance with
pencil thin cortex.

37. RADIOLOGICAL FINDINGS
 Metaphysis demonstrate a zone
of well calcified cartilage,
referred to as WHITE LINE OF
FRENKEL.
 Epiphysial centres of ossification
are surrounded by a white ring
(WIMBURGER SIGN)

38. RADIOLOGICAL FINDINGS
 The zone of rarefaction is a
linear break in the bone
proximal and parallel to white
line.
 The lateral part of zone
appears as a triangular defect.
 Epiphysial separation may
occur.

39. RADIOLOGICAL FINDINGS
 A) Early scurvy: White lines
on the ends of shaft of tibia
and fibula
 Separation of epiphysis of
femur & tibia
 B) Zone of destruction in
femur
A B

40. RADIOLOGICAL FINDINGS
 A) AP view of lower extremities
showing :
1. Ground-glass osteopenia,
2. Trummerfeld zone &
3. Pelkan spurs.
A B

41. BIOCHEMICAL FINDINGS
 The ascorbic acid concentration of the
white cell/platelet layer (BUFFY LAYER) of
centrifuged oxalate blood is an indicator of
vitamin C status.
 A level of zero in this layer indicates latent
scurvy, even in the absence of clinical
signs of deficiency.

42. TREATMENT
 ASCORBIC ACID
100-300 mg/day
provides quick relief.

43. PRETREATMENT & POSTTREATMENT

44. Toxicity Symptoms
 What are toxicity symptoms for vitamin
C?
 At high supplemental doses involving 5 or
more grams of vitamin C, diarrhea can
result from the fluid in the intestine
becoming too concentrated
("osmotic diarrhea").

45. Toxicity Symptoms
 Large supplemental doses of vitamin C can
also increase levels of uric acid in the urine,
because vitamin C can be broken down
into uric acid.
 Vitamin C can increase a person's
absorption of iron from plant foods

46. Toxicity Symptoms
 It is important to
remember that all of
the above toxicity-
related issues involve
vitamin C in
supplemental form, not
as it naturally occurs in
food.

47.  1). Vitamin C is present in largest amount
in body in –
1. Eye
2. Kidney
3. Testes
4. Adrenal cortex
Ans.- 4

48.  2). Conversion of proline to
hydroxyproline is brought about by –
1. Vit.C mediated hydroxylation
2. Reverse hydroxylation
3. Inversion
4. Post translation induction
Ans.- 1

49.  3). A vitamin which serves as a reducing
agent is –
1. Vit C
2. Vit D
3. Folic acid
4. Thiamine
Ans.- 1

50.  4). Which of the following vitamin acts as
respiratory catalyst? –
1. Thiamine
2. Riboflavin
3. Cyanocobalamine
4. Ascorbic acid
Ans.- 4

51.  5). Pelcan spur is a feature of deficiency
of which vitamin? –
1. Vit E
2. Vit C
3. Vit K
4. Vit A
Ans.- 2

52.  6) What percentage of vitamin C in
vegetables is destroyed by boiling?
1. 20%
2. 25%
3. 30%
4. 35%
Ans.-2

53.  6). The highest quantity of vit C is found
in-
1. Orange
2. Lemon
3. Indian gooseberry
4. Grapes
Ans.- 3

54.  7) The requirement of vitamin C in
pregnancy is:
1. 30 mg
2. 40 mg
3. 60 mg
4. 80 mg
Ans.- 2

55.  8) Radiological features of vitamin C
deficiency are best seen in:
1. Wrist joint
2. Elbow joint
3. Knee joint
4. Hip joint
Ans.-3

56.  9) Limeys are:
1. British sailors
2. French sailors
3. German sailors
4. Indian sailors
Ans.-1

57.  10) Which of the following animals cannot
synthesise vitamin C in their own body?
1. Gorillas
2. Chimps
3. Humans
4. All of the above
Ans.-4