A 18-month-old child from rural India presents with bleeding gums, petechial rash, and poor wound healing. Serum vitamin C level is low. What is the drug of choice for treatment?

Explanation

## Vitamin C Deficiency (Scurvy) in Children ### Clinical Presentation **Key Point:** Scurvy manifests as bleeding gums, petechiae, ecchymoses, poor wound healing, and follicular hyperkeratosis due to defective collagen synthesis. ### Pathophysiology Vitamin C (ascorbic acid) is an essential cofactor for prolyl and lysyl hydroxylase enzymes required for collagen cross-linking. Deficiency impairs connective tissue integrity, leading to hemorrhage and impaired wound healing. ### Drug of Choice **High-Yield:** Ascorbic acid (vitamin C) 100–200 mg daily is the first-line and definitive treatment for scurvy in children. ### Dosing & Duration | Parameter | Details | |-----------|----------| | **Dose** | 100–200 mg daily (therapeutic) | | **Route** | Oral (preferred); IV if severe malabsorption | | **Duration** | 2–4 weeks until clinical resolution | | **Dietary sources** | Citrus fruits, tomatoes, leafy greens, amla | ### Clinical Response **Clinical Pearl:** Bleeding gums improve within 1–2 weeks; petechiae resolve within 2–4 weeks. Dietary counseling on vitamin C–rich foods is essential for prevention in resource-limited settings. ### Prevention in High-Risk Groups - Exclusively bottle-fed infants without fortified formula - Children with restricted diets (autism, severe malabsorption) - Populations with limited access to fresh produce **Mnemonic:** SCURVY = **S**corbutic (bleeding) **C**ollagen defect **U**nder **R**epair **V**itamin C **Y**earning