SCURVY

TSINGA (syn: scurvy) - avitaminosis or hypovitaminosis C in the stage of detailed clinical manifestations. In the absence or deficiency of ascorbic acid, the formation of various elements of connective tissue, including collagen, is impaired, which leads to a decrease in strength and increased permeability of the vascular walls, hemorrhages, disruption of the cartilage and bone structure, weakening of the connection between them, as well as between the diaphysis and epiphyses of tubular Bones, teeth and alveolar processes of the jaws, to a decrease in bone marrow function. Usually scurvy symptoms are combined with manifestations of other types of vitamin deficiency.

The first signs of scurvy occur after 4-12 weeks after stopping the intake of vitamin C, and if it is insufficiently supplied with food (hypovitaminosis C) - after 4-6 months. There are general weakness, lethargy, fatigue, irritability, drowsiness, dizziness , indeterminate pain in the calf muscles and joints, weight loss. These symptoms are not specific, but they allow suspected scurvy if they were preceded by fasting or eating foods that do not contain vitamin C, as well as prolonged diarrhea with malnutrition due to a violation of food intake in the intestines.

Later, the scabies characteristic of scurvy are noted: the gums are initially pale, then become cyanotic, the interdental papillae swell and bleed at the slightest touch to them; Around the teeth appear spongy blue-purple growths, forming rollers; In these sprawl - hemorrhage. Patients noted pain when chewing and increased salivation. In severe scurvy, as well as in the presence of sick teeth, a secondary infection joins, gums appear on the gums, an unpleasant odor from the mouth is noted, the teeth loosen and fall out. The skin becomes dry, acquires a yellowish-brown hue; Characterized by hemorrhages in the skin (mainly on the lower limbs), which are located mainly around the hair follicles, protrude above the level of the skin and give it the appearance of a grater. At first, hemorrhages have a red color, then they acquire a blue-purple and brownish hue. In severe cases, extensive hemorrhage in the conjunctiva, subcutaneous tissue (mainly in the buttocks, hamstrings and popliteal pits), into the muscle mass (more often the gastrocnemius), under the periosteum, in the tissue around the joints. With significant hemorrhages, visible solid hematomas form causing pain. Because of pain in the muscles and joints, the movement of patients is difficult, often they walk, bending their knees. Possible hemorrhages in internal organs (for example, stomach, intestines, lungs, kidneys, pleura, pericardium), as well as in the anterior chamber of the eye. In such cases, bloody vomiting , hemoptysis, hematuria , etc. can be attached to the manifestations of the disease. In the course of scurvy, the motor and secretory functions of the stomach and intestine are suppressed, anemia is often observed, an increase in the spleen, sometimes the liver, is often observed. Heart attacks (dyspnea, palpitations, weakening of the heart beat, dull tones, etc.) are usually associated with a deficiency in food of other vitamins or protein, or due to the attachment of infectious and other diseases.Due to hemorrhages in various tissues, complications may occur - fractures of bones, persistent limitation Mobility in the joints, etc.

Treatment consists in the appointment of a full-fledged diet with the inclusion of foods rich in vitamin C (fresh fruit, berries, vegetables, juices), as well as preparations of ascorbic acid inside or parenterally 250 mg 4 times a day until bleeding disappears (usually within 2 to 4 weeks ) With a subsequent decrease in the daily dose to 200-100 mg. In children, the initial daily dose is 100-300 mg. To reduce the inflammation of the oral mucosa, rinse with a mild disinfectant solution of potassium permanganate, hydrogen peroxide, oil solutions of vitamins A and E. In anemia, prescribe iron, vitamin B12. In the presence of muscle infiltrates and with limited mobility in the joints, physiotherapeutic procedures are performed, including baths, massage; Prescribe therapeutic gymnastics.

The prognosis of uncomplicated scurvy with timely treatment is favorable; With complications, it depends on their nature (loss of vision, joint stiffness, etc.). Accession of acute infectious diseases ( influenza , pneumonia , sepsis , etc.) can lead to death.

Individual prevention of scurvy is necessary in the winter-spring period, when the content of vitamin C in the diet decreases.

You should use canned vegetables, fruit juices, freshly frozen berries, broths of wild rose. Preservation of vitamin C in products is promoted by observance of rules of their storage and culinary processing. With insufficient quantity of vegetable and fruit dishes, it is advisable to take ascorbic acid, based on the daily requirement of the organism in it (in children from 30 to 75 mg per day, in adults 50-120 mg), complex vitamin preparations (undevit, etc.).