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The child's presentation was suggestive of scurvy. Testing of the serum ascorbic acid level was ordered, and the patient was discharged on 300 mg of ascorbic acid daily and a multivitamin. One week after discharge, his gingival swelling and petechiae resolved. By 1 month, he was ambulating and his hemoglobin level was 12.2 g/dL. The ascorbic acid level on the initial testing was 1.057 × 10−4 mg/dL (reference range, >4.227 × 10−4 mg/dL; to convert to micromoles per liter, multiply by 56.78).
Scurvy is thought to linger among alcoholic and disadvantaged individuals. However, vitamin C deficiency in children with developmental disorders who consume restricted diets may be more common than thought. Noble et al1 reported 23 case studies of scurvy in children with restricted diets, including children with autism, developmental delay, and cerebral palsy.
Picture of the Month—Diagnosis. Arch Pediatr Adolesc Med. 2012;166(5):480. doi:10.1001/archpediatrics.2011.1247b
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