Poster Presentation ESA-SRB Conference 2015

Vitamin C deficiency is rarely diagnosed in the modern era. With the Australian population eating more discretionary food and inadequate vegetables, it is possible that Vitamin C deficiency is becoming more prevalent. Groups with a greater tendency to avoid certain foods are at risk of developing manifest scurvy.

A 25 year old male with a lifelong history of Type 1 diabetes and a 10-year history of Coeliac disease attended Diabetes Clinic with multiple lesions on the anterior lower limbs.  He stated they resulted from having dropped sheet metal on his legs three days prior. He was admitted with hyperglycaemia and non-acidotic ketosis, weight loss of 29% (22kg) over 6 months and microcytic anaemia. Vitamin C deficiency was suspected after dietary history revealed irregular compliance with gluten-free diet and minimal intake of fresh fruit and vegetables. Low vitamin C level was confirmed at 19 umol/L (normal > 40).

Antibiotics, oral vitamin C, vitamin D and iron supplementation were commenced. Psychiatry review excluded disordered eating. After discharge he stopped taking vitamin supplements and his vitamin C level was not replete at 30 umol/L. His leg wounds remained open but not infected. Two months later he lost a further 3kg weight, suffered postural dizziness and his leg wounds still had not healed. His vitamin C level was 35 umol/L with intermittent adherence to oral replacement. He started consistently taking 2000 mg daily and vitamin C level improved to 181 umol/L one month later. His wounds healed despite ongoing poor glycaemic control (HbA1c 12.2% from 11.7% previously).

Conclusions:

Although this patient had several potential factors contributing to his non-healing wounds, only achieving adequate Vitamin C replacement correlated temporally with wound healing. Vitamin C deficiency should be considered in patients with diabetes and non-healing wounds as the treatment is simple, affordable and safe.