Scurvy: a terrible consequence of a lack of vitamin C. Causes, symptoms and prevention of scurvy disease Scurvy disease occurs when there is a deficiency

The disease scurvy was widespread in the 17th and 18th centuries, when it killed many people. This is not an infectious disease that could spread from person to person, but nevertheless, scurvy affected large sections of the population, children and adults died from it. The pathology was especially common among prisoners and sailors, as well as elderly people living in groups. It's all about the lack of the most important element for the body - vitamin C, which can lead to serious and even fatal consequences.

History and discovery of scurvy

Even during the Crusades (13th century), there were records that people suffered from a strange disease that led to hemorrhages on the skin, internal organs, and mucous membranes. The pathology was especially common among ship crew members returning from long voyages, so scurvy received a second name - sea scurvy. Great geographical discoveries And round the world travel even more influenced the incidence of the disease: sometimes even the strongest and healthiest sailors returned decrepit and crippled from such trips. According to rough estimates, over 200 years (from 1600 to 1800) more than 1 million sailors died from scurvy. Land losses did not “lag behind” sea losses: in crowded places - in prisons, remote villages, nursing homes of that time, many patients died from scurvy.

If earlier there were theories about the closeness of scurvy to plague and typhus due to the nature of the pathogen, then later people noted that the consumption of citrus fruits seriously reduces mortality from insidious disease. In this regard, by the beginning of the 18th century, sailors of the state fleet began to receive rations with oranges and lemons, as well as cranberries, sauerkraut and other seasonal products that were selected through trial and error. But only in the middle of the 20th century was it clearly proven that the causes of scurvy are associated with a lack of vitamin C and nothing else.

The prevalence of scurvy in ancient times was geographically very wide. It was observed especially often among expeditions going to the northern seas, and on land in the countries of the North. Died from scurvy in Russia great amount people at the end of the 19th century, and this was its last major "epidemic", although during the Great Patriotic War The army also suffered from sporadic outbreaks, especially in besieged cities. The connection is clearly visible mass cases diseases with the onset of lean years, when there was real famine in the regions. Similar situations existed in Europe, some US states and even in Australia.

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Description and causes of the disease

Scurvy (scorbut) is a disease whose symptoms arise against the background acute shortage Vitamin C. Deficiency ascorbic acid provokes disruption of collagen production, as a result of which connective tissue fibers lose elasticity and strength. In other words, scurvy is an acute vitamin deficiency of ascorbic acid, expressed in the form of hemorrhages in the muscles, tissues, skin and mucous membranes, accompanied by disruption of the bone structure and disruption of the functioning of almost all organs. If the disease occurs in young children, it is often referred to as “hemorrhagic rickets” or “rickets scorbutus.”

Vitamin C is essential to the human body, which simply cannot function normally without this substance. It is not produced by itself and must be supplied regularly with food. Lack of vitamin causes scurvy, and this is the only etiological factor development of this disease. Symptoms of scurvy can occur after 1-3 months of lack of ascorbic acid in the body. Similar cases can occur in the following situations:

• fasting, including following strict diets;
• food consumption low quality products, semi-finished products, refined foods, canned foods that do not contain vitamin C;
• monotonous diet in winter time with the absence plant food(for example, among the peoples of the North).

In newborns and infants, scurvy can occur even while breastfeeding, if the mother does not consume foods rich in the required element.

Vitamin C hypovitaminosis is often observed if the child is not fed balanced milk formulas, but boiled milk without vitamin supplements. There are also factors that speed up the consumption of ascorbic acid in the body, so scurvy can develop even faster. These include:

• hard physical labor;
• playing sports;
• tolerable stress;
• serious and persistent infections;
• pregnancy, repeated pregnancies.

Vitamin deficiency of ascorbic acid is very often combined with a lack of other vitamins, which provokes the development various violations in the body and different clinical picture pathology. The pathogenesis of scurvy is:

1. Against the background of a decrease or complete absence element, the production and maturation of mesenchymal cells, including osteoblasts, fibroblasts, which are responsible for the formation of intercellular substance, are disrupted connective tissue.
2. The formation of collagen, the main substances of cartilage and bones, as well as blood vessels. The function of the adrenal glands is gradually impaired.
3. The capillaries become more permeable, resulting in characteristic focal hemorrhages. Most often, hemorrhages are observed in organs that are subject to movement or friction - gums, tendons, muscles, joints.
4. Infiltrates form along the vessels, causing inflammatory areas and zones of hyperpigmentation to appear. The process is accompanied by the development of a clinical picture, including severe pain, limited joint mobility, etc.
5. Hemorrhages begin to appear in internal organs - kidneys, lungs, heart, intestines. Bone fractures occur against the background of severe osteoporosis, and anemia is diagnosed. Anti-infective property decreases immune system. General exhaustion is observed, during this period the patient may die from complications of scurvy.

Symptoms of scurvy

As a rule, the most initial symptoms pathologies appear 1-3 months after the end of consumption of food with vitamin C. If a person still has a source of ascorbic acid in the body, but it is too insignificant, signs of scurvy appear later - only after 5-6 months. Early symptoms the scurvy are as follows:

• lethargy, weakness;
• decline in performance;
• bad mood, depression;
• dizziness, headaches;
• lack of vigor, constant drowsiness;
• pain in muscles, joints;
• weight loss.

These components of the clinical picture do not characterize scurvy as the only possible disease in this situation, so not every specialist can suspect scurvy. Often only when severe weight loss and exhaustion with recurring diarrhea, which is combined with poor nutrition, we can conclude that vitamin deficiency occurs. With absence emergency assistance The body at this stage of scurvy progresses and leads to the development of the following symptoms:

• pallor, cyanosis of the gums;
• swelling and bleeding of the gums even with a light touch;
• the appearance of areas of hemorrhage on the gums, around which foci of purple growths appear in the form of ridges;
• pain in the gums, aggravated by chewing food and talking;
• increased salivation;
• the appearance of ulcers that can become secondarily infected with bacterial particles (scorbutic ulcerative stomatitis);
• unpleasant putrid smell from mouth;
• tooth loss.

Along with gum dysfunction, other pathological changes throughout the patient's body. The skin is covered age spots and, in general, becomes overdried, brownish-yellow in appearance. Hemorrhages of varying sizes are observed in skin, more often - on lower limbs in area hair follicles(head injury in the area hairline not typical for scurvy). Small hemorrhages have swelling around them, making the skin uneven, like the surface of a grater.

Severe forms of scurvy, if left untreated, lead to hemorrhages in the following areas of the body:

• conjunctiva;
• back of the thigh;
• buttocks;
• calf muscles;
• feet;
• popliteal cavities;
• forearms;
• joints;
• periosteum.

Areas of hemorrhage become hard, swollen infiltrates, causing pain to the person and preventing normal movement. With major bleeding, the limb becomes very swollen and becomes immobile. Complications of scurvy are hemorrhages in internal organs, in the eyes. In this case, the sick person may experience vomiting blood, bloody diarrhea, hemoptysis, abdominal pain, and blood in the urine.

The liver and spleen increase in size, the functioning of the intestines and stomach is seriously disrupted, and severe anemia. Crashes and the cardiovascular system- the heart rhythm changes, blood pressure drops, and shortness of breath develops. Fractures of bones, especially tubular ones, are very common.

Death can occur from massive hemorrhage, chronic blood loss and anemia, sepsis due to secondary infection, peritonitis with gangrenous enterocolitis and a host of other complications of scurvy.

Carrying out diagnostics

The diagnosis is made on the basis of the emerging clinical picture, as well as after clarifying the nature of nutrition and lifestyle (the presence of physical activity and other situations that could affect the increased consumption of ascorbic acid is especially noted). There are three degrees of severity of scurvy, which should be taken into account when making a diagnosis:

1. The first degree is sore gums, muscle weakness and a general decline in performance, a tendency to bleeding gums. Available initial signs scurvy stomatitis, elements of hemorrhages on the extremities.
2. Second degree - severe pain in the legs, the presence of intra-articular and muscle hemorrhages. The person cannot fully move, there is severe weight loss, the skin is hyperpigmented and peeling. The gums are bluish, the teeth are loose.
3. Third degree - general serious condition person, the addition of hemorrhages in internal organs and other complications. There is gangrenous gingivitis, skin ulcers, fractures, and separation of the cartilage of the ribs.

For a more reliable diagnosis of scurvy, a blood test is performed to determine the concentration of vitamin C in the body. If such an analysis cannot be performed for any reason, then the diagnosis is confirmed after the patient’s condition improves in response to taking large doses of ascorbic acid for 1-2 weeks. also in mandatory conduct a density study bone tissue(densitometry), a series of radiographic examinations to detect fractures and changes in osteochondral joints. Scurvy should be differentiated from hemorrhagic diathesis, with rickets in children, with hemophilia, acute lymphadenosis, acute aleukemic myelosis, rheumatism.

Treatment methods

In case of moderate to severe disease, the person is hospitalized. In mild cases, therapy at home is possible under the strict supervision of a doctor. Ascorbic acid 100 mg is prescribed. up to 5 times a day for a course of up to 2-3 weeks. IN difficult cases practiced injection vitamin C in even higher concentrations for about the same time.

Additionally, the patient is prescribed a diet, including foods with high content element - greens, fruits, vegetables, as well as decoctions of rose hips, pine needles, cedar, fir. To make a decoction, pour 200 g of pine needles into a liter of boiling water, cook for 20 minutes over low heat, and filter. Drink 1-3 glasses a day, adding sugar or honey. This method of treating scurvy is well suited when it is impossible to organize a diverse and rich in vitamin nutrition.

For complications associated with bleeding, the patient may require administration of blood thickening drugs, as well as blood transfusions. Secondary bacterial complications treated with systemic and local antibiotics. It will be useful to take vitamin-mineral complexes, especially vitamins A, E, B12, as well as iron supplements for anemia. The gums are irrigated with antiseptics Miramistin, Chlorhexidine, Octenisept, and rinsed with a solution of Furacillin, potassium permanganate, hydrogen peroxide, etc. Loose and diseased teeth are removed or treated. The patient is also shown Spa treatment, water treatments, massage, physiotherapy, exercise therapy to increase the body's resistance and speedy recovery after scurvy.

Therapy with folk remedies

In addition to decoctions coniferous trees, which even recommends treating scurvy traditional medicine, there are a number folk remedies from this unpleasant disease:

1. Squeeze the juice of 1 lemon into a glass, dilute with water, add jam, honey, sugar to taste. Drink it a day, and without adding sweeteners, rinse your mouth with this water three times a day.
2. Take 20 g of sea buckthorn leaves and fruits, pour 250 g hot water, leave for 6 hours. After straining, drink 100 ml four times a day.
3. Mix 20 g of hop cones and primrose leaves, pour 500 ml of boiling water, leave for an hour. Drink 100 ml three times a day.
4. Squeeze the juice from cranberries, drink a tablespoon 3 times a day, or eat the berries themselves every day. Lingonberries, raspberries, and strawberries are also excellent for treating scurvy.

Prevention measures

Since untreated and advanced cases of scurvy most often end in death or disability, it is better to take all measures to prevent this pathology. To do this, you just need to watch your diet and eat more plant foods that are rich in vitamin C - all berries, potatoes, cabbage, apples, herbs, tomatoes, red peppers, horseradish, citrus fruits, etc. In spring and winter period It is better to take additional vitamin C in the form of medications (Revit, Undevit, multivitamins). Also, supplementing the diet with ascorbic acid in preparations is necessary for people whose labor costs exceed the average, as well as for pregnant women and women during lactation.

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Scurvy (synonymous with scurvy) is a disease caused by a long-term lack of vitamins C and P in the body.

Etiology. Scurvy develops when there is insufficient intake of vitamin C from food or insufficient absorption of it in the intestines. Preservation of vitamin C is possible only in the presence of vitamin P. Predisposing factors play a major role in the development of scurvy: 1) nutrition mainly with insufficient amounts of animal proteins; 2) infections (acute and chronic), since they increase the need for ascorbic acid; 3) diseases digestive tract, especially small intestine; 4) unfavorable working and living conditions - excessive exercise stress, insufficient, lack of light and air, etc.

Pathogenesis. With a lack of ascorbic acid in the body, cell maturation is disrupted. As a result, changes occur in the bones and bone marrow. Since iron absorption is simultaneously reduced, hypochromic anemia may develop. Impaired collagen synthesis leads to increased fragility of the capillary walls, which explains the bleeding characteristic of scurvy. With a lack of ascorbic acid in the body, a decrease in adrenal function is observed, which leads to muscle weakness, some decrease in metabolism, blood pressure and body resistance.

Pathological anatomy. Characterized by disorganization of connective tissue with impaired bone growth, disruption of the connection between the roots of the teeth and the alveolar processes; degeneration of collagen fibers, fragility of blood vessels, multiple hemorrhages in the mucous membranes of the oral cavity, tonsils, muscles, skin, and sometimes in internal organs.

There is dystrophy of the adrenal glands with the disappearance of ascorbic acid reserves in them and other glands internal secretion, decreased glycogen reserves and fatty infiltration in liver cells.

Clinical picture(signs and symptoms). There are three stages clinical course scurvy.

The first, hidden, stage of scurvy usually lasts from one week to several months. At first latent stage There is increased skin sensitivity, chilliness, fatigue, weakness, drowsiness, and pain in the legs. Patients are pale, their lips and face are somewhat cyanotic, the skin is a characteristic grayish, dirty gray or bronze color, petechiae appear, mainly on the legs.

In the second stage, hemorrhages come to the fore. Petechiae are found all over the body except the face, palms and feet. Possible clinical manifestations hemorrhages of internal organs (blood in stool, hematuria, etc.). Large hemorrhages into the muscles are accompanied by severe pain, swelling and severe limitation of movements. Chewing causes pain and bleeding from the gums.

The third stage is characterized by the extensiveness and prevalence of hemorrhages. Ulcers appear on the affected areas of the skin and mucous membranes, gingivitis increases, and hemorrhages occur at the site gastrointestinal tract Ulcers form and may bleed. A septic condition may occur. From the outside, dullness of tones is noted, myocardial dystrophy is detected, and in some cases blood pressure is significantly reduced.

In 20% of cases, the third stage of scurvy is accompanied by hypochromic anemia (see), significant lymphocytosis, and moderate neutropenia. Indicators, bleeding time and content have not changed. Formation of bilirubin in areas of hemorrhage and dystrophic changes liver may cause mild jaundice. Metabolism is characterized increased secretion with urine of the final products of protein metabolism, a general negative balance of nitrogen metabolism.

Complications: contractures, ankylosis, skin ulcerations, hemorrhages in the cavity (pericardium, etc.), internal organs, necrosis of the alveolar edge, secondary infection.

Forecast at timely treatment scurvy - favorable; worsens with complications of scurvy infectious diseases, as well as in cases where scurvy is combined with tuberculosis, severe dysentery.

Treatment. Administration of ascorbic acid orally (500-1500 mg) and intravenously (300-600 mg) in combination with vitamin P 300-450 mg per day orally. Vitamins of group B are also shown: (50 mg intramuscularly) and (10-30 mg orally). The duration of treatment is about a month. Then the dose of ascorbic acid is reduced to 200-100 mg per day. The patient's diet during the treatment period should be varied, including 100-150 g of proteins per day, vitamins, etc. Depleted patients are prescribed 100 ml every 2-3 days, 4-6 times in total.

Prevention. Introduction to plant products, rich in ascorbic acid (tomatoes, green onions, cabbage, horseradish, currants, apples, lemons, oranges). In the northern regions, it is advisable to add vegetable concentrates, infusion, and canned black currants to the diet. In their absence, it is necessary to recommend taking ascorbic acid orally at 70-80 mg per day, which provides the daily requirement for vitamin C. But even small doses of ascorbic acid (20-25 mg per day) prevent the development of scurvy.

Scurvy (synonymous with scurvy) is a disease caused by a long-term lack of vitamin C in the body.

Etiology. The disease is associated with insufficient intake of vitamin C from food or insufficient absorption. To preserve vitamin C, the presence of vitamin P is mandatory. The manifestation of the disease is associated with individual characteristics organism, depending on gender, age, functional state nervous and digestive systems. Therefore, sometimes clinical manifestations may be absent even with low levels of vitamin C in the blood.

Predisposing factors play a major role in the development of scurvy: 1) nutrition predominantly of carbohydrates with insufficient amounts of animal proteins; 2) infections (acute and chronic); they cause a rapid transition from the latent stage of scurvy to the overt stage, since with any infection the need for ascorbic acid increases; 3) pathological conditions digestive organs, especially the small intestine; 4) the nature of the work and environmental conditions (excessive physical activity, insufficient sleep, lack of light and air, etc.).

The pathogenesis of scurvy is not well understood. Understanding the pathogenetic essence of scurvy is based on the participation of ascorbic acid in the formation of collagen and its varieties, which are part of the main intermediate substance of the vascular endothelium, reticular and connective tissue, cartilage, bone, and dentin.

Lack of sufficient collagen production, as if cementing individual cells vascular endothelium, creates increased permeability capillaries and is the main cause of bleeding during scurvy. This has now been confirmed by electron microscopic studies.

The darkening of the skin observed in some patients is associated with a decrease in adrenal function.

With scurvy, disturbances occur in oxidative processes, as well as carbohydrate and protein metabolism, which is associated with a decrease in the redox properties of ascorbic acid.