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Call child protective services
10%
1/10
Obtain complete blood count
20%
2/10
Test plasma vitamin C levels
Admit to hospital for enteral nutrition
0%
0/10
Supplement ascorbic acid
60%
6/10
Select Answer to see Preferred Response
This patient presents with petechiae, gingival hemorrhage, and coiled body hair, most consistent with vitamin C deficiency or scurvy. The best next step in management upon clinical suspicion of scurvy is supplementation with vitamin C. While vitamin C (ascorbic acid) deficiency is now very rare in the developed world, malnourished patients or those with particular eating habits, such as children with autism spectrum disorder, can be affected. Empiric supplementation with vitamin C is the first-line treatment if scurvy is suspected. Increased intake of citrus fruits, which are high in vitamin C, is also recommended if the patient is able to tolerate them. Resolution of symptoms with increased vitamin C intake confirms the diagnosis. Figure A shows diffuse petechiae on the leg. Figure B shows gingival hemorrhage. Incorrect Answers: Answer 1: Calling child protective services would be warranted if there were suspicion of child abuse. Ecchymoses are more common signs of abuse than petechiae, and although nutritional deficiency is suspected, there is ample reason to believe that this is due to the child’s dietary preferences as opposed to neglect. Answer 2: Obtaining a complete blood count might be useful if platelet disorders such as immune thrombocytopenia were suspected, as they can also cause diffuse petechiae and bleeding gums. However, this patient’s combination of symptoms (in particular corkscrew hairs) is suggestive of scurvy, and lab testing is not required for diagnosis of this condition. Answer 3: Testing plasma vitamin C levels is typically not performed for confirmation of scurvy. The diagnosis is primarily made based on clinical presentation, as blood tests often do not correlate well with functional vitamin C status. Answer 4: Admission to the hospital for enteral nutrition would be required if this patient were suffering from hemodynamic instability or orthostasis due to poor dietary intake. This patient is seemingly able to feed himself but has a specific nutritional deficiency, so general enteral nutrition is not indicated. Bullet Summary: Scurvy presents with petechiae, gingival hemorrhage, and corkscrew hairs, and the best initial step in management is supplementation with vitamin C.
3.9
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