RESUMO
El escorbuto es una enfermedad ocasionada por el déficit de vitamina C. La vitamina C, también llamada ácido ascórbico, actúa como cofactor de la propil-lisil hidroxilasa, enzima que interviene en la biosíntesis de colágeno; por ello es de vital importancia en la integridad estructural de piel, mucosas, anexos, vasos sanguíneos, huesos y dientes. Las manifestaciones clínicas incluyen síntomas constitucionales severos como debilidad y fatiga. Los hallazgos cutáneos iniciales son pápulas hiperqueratósicas foliculares y púrpura palpable perifolicular. Con el tiempo aparecen áreas extensas de equimosis, edema en miembros inferiores, hemorragias en astillas en uñas y alopecia difusa. Por lo general se describe esta enfermedad como asociada a tiempos pasados y extremadamente infrecuente en países desarrollados. Sin embargo, actualmente se ha detectado un aumento en el número de casos, asociados con malnutrición severa. Desórdenes psiquiátricos como la anorexia nerviosa, alcoholismo y deficiencias nutricionales por dietas excesivas y mal balanceadas o escasez de recursos económicos constituyen los principales factores de riesgo hoy en día. El tratamiento consiste en la corrección del déficit mediante la mediante suplementación con vitamina C vía oral. Presentamos una mujer de 24 años con escorbuto asociado a anorexia nerviosa y a dieta pobre en vegetales y fruta.
Scurvy is a disease caused by a deficit of vitamin C. Vitamin C, also called ascorbic acid, acts as a cofactor for propyl-lysyl hydroxylase, an enzyme that is involved in collagen biosynthesis, vitally important in the structural integrity of skin, mucous membranes, annexes, blood vessels, bones and teeth. Clinical manifestations include severe constitutional symptoms such as weakness and fatigue. The initial cutaneous findings are follicular hyperkeratotic papules and perifollicular palpable purpura. Over time, large areas of ecchymosis, edema of the lower limbs, splinter hemorrhages in nails and diffuse alopecia appear. Usually this disease is described as associated with past times and extremely uncommon in developed countries. However, the number of cases have been increasing, especially those associated with severe malnutrition. Psychiatric disorders such as anorexia nervosa, alcoholism and nutritional deficiencies due to excessive and poorly balanced diets or shortage of economic resources are the main risk factors nowadays. Correcting the deficit with oral vitamin C supplementation is the treatment of the disease. We present a 24-year-old woman with scurvy associated with anorexia nervosa and a diet low in vegetables and fruit.
Assuntos
Humanos , Feminino , Adulto , Púrpura , Ácido Ascórbico/uso terapêutico , Deficiência de Ácido Ascórbico/terapia , Escorbuto/diagnóstico , Deficiências Nutricionais/terapia , Desnutrição/complicações , Diagnóstico PrecoceRESUMO
The list of vitamins recognized as essential in human nutrition is extensive. Only some of them, however, are attributed an important role in public health. The present paper deals with three of these selected because their deficiencies still prevail in important sectors of population in the Latin American Region: vitamin A, vitamin C and vitamin D. For each vitamin the paper discusses the scientific bases for their requirements, as well as pragmatic considerations to be taken into account for the derivation of recommended dietary intakes. Reference is made to the logic of applying the concepts of nutrient density when developing guidelines for the design of diets for the family and the community. Adequate nutrient density means that when a diet is consumed in sufficient amounts to satisfy energy requirements, the needs for essential nutrients are also being met. For the above reasons, the principle of expressing the recommended levels of intake of vitamin A and C per 1,000 kilocalories has been followed. This is not the case with vitamin D which, in view of its special feature of being synthesized endogenously, is not really a vitamin in the strict sense of the term and, therefore, a rational and consistent relationship with the energy of the diet cannot be established.