Vitamin A- Symptoms:Night Blindness, Bilateral Dry Eyes,
- Signs:
- Squamous Metaplasia with generalized hyperkeratinization, Follicular Horny Papules;
- Punctate Keratitis, Corneal Neovascularization, Keratomalacia (Corneal Melting); Bitot's Spot;
- Labs / Investigation:
- B12 (B12 and Vitamin A gets absorbed in distal intestine)
- Protein Level (Ocular findings will be worse if hypoproteinemia is present)
Case 1-2014: A 32-Y-O-M with Loss of Vision and a Rash (Vitamin Deficiency A, C, and D)
eBitot’s Spot in Vitamin A Deficiency NEJM Vitamin C- Symptoms: Lassitude, Fatigue, Depression, Vasomotor Instability, Limb pain (Subperiosteal Bleeding), Bleed easily (Gums / Skin) hematomas, Diet mainly soda and toaster diet,
- Signs: Petechia, Ecchymoses, Perifollicular Purpura, Corkscrew Hair, Follicular Hyperkeratosis (Phrynoderma), Perifollicular Hemorrhages, , sacral osteopenia, Gingival hypertrophy, Anemia
- Labs / Investigation:
- Ring Sign, Pelkan's Sign, Frankel's sign (White line), Lucent Line (Trummer feld zone or Scurvy Line)
- Diagnosis:
- Vitamin C levels (2 methods)
- Serum Ascorbic Acid Assay
- WBC Ascorbic Acid Assay
- Note:
- If the skin looks hyperkeratotic, Scurvy should be placed in the differential diagnosis
- Treatment:
- 1-2 g of Ascorbic Acid for 2-3 days; 500 mg after that for a week; Then, 100 mg daily for 1 - 3 months
Case 23-2007 (9 yr old, Rash/Ginigival Hypertrophy)
Lower Extremity Purpura (Case Challenge) JAMA 2011 Vitamin D
Rickets Lancet 2014
Vitamin D Deficiency NEJM 2007
Osteomalacia (Image in Clinical Medicine) NEJM
Severe Vitamin D Deficiency (Image in Clinical Medicine) Rickets NEJM Vitamin E- Progressive Motor and Sensory neuropathy,
- Ataxia
- Retinal Degeneration
- Hemolytic Anemia
Vitamin K- Bleeding (external and internal organs)
Folate and B12
Thiamine (B1)Deficiency (Beriberi)
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