What additional findings would be expected in a patient on a milk-based diet who presents with gum bleeding, possibly indicating a vitamin deficiency?

From the Guidelines

A patient on a milk-based diet who presents with gum bleeding is likely to have a vitamin C deficiency, and additional findings may include perifollicular hemorrhage, corkscrew hairs, hyperkeratosis, and joint pain. These findings are characteristic of scurvy, a disease caused by insufficient intake of vitamin C, which is essential for collagen synthesis 1. A milk-based diet lacks adequate vitamin C, leading to impaired collagen synthesis and fragile blood vessels, causing characteristic hemorrhages around hair follicles and bleeding gums. Other symptoms of vitamin C deficiency may include petechiae, ecchymoses, and poor wound healing. Vitamin C is essential for hydroxylation of proline and lysine in collagen formation, and its deficiency compromises the structural integrity of blood vessels and connective tissues. Some key points to consider in this patient include:

• The importance of vitamin C in collagen synthesis and its deficiency leading to scurvy
• The characteristic findings of scurvy, including perifollicular hemorrhage and gingival bleeding
• The need for vitamin C supplementation to resolve symptoms
• The potential for other symptoms, such as corkscrew hairs, hyperkeratosis, and joint pain, to be present. It is also worth noting that while vitamin K deficiency can also contribute to bleeding, the patient's symptoms and diet suggest a vitamin C deficiency as the more likely cause 1.

From the Research

Expected Findings in a Patient with Vitamin Deficiency

In a patient on a milk-based diet presenting with gum bleeding, several additional findings would be expected, indicating a possible vitamin deficiency. The studies suggest that a deficiency in vitamin C could be the cause of these symptoms 2, 3, 4, 5, 6.

Clinical Manifestations

Some common clinical manifestations of vitamin C deficiency include:

• Gingival bleeding and hyperplasia 2, 5, 6
• Arthralgias and myalgia 2, 4
• Skin discoloration and perifollicular hemorrhage 2, 3
• Impaired wound healing and ecchymoses 2
• Vascular purpura and hemorrhagic syndrome 4

Biological Signs

Biological signs of vitamin C deficiency may include:

• Anemia 4
• Hypocholesterolemia 4
• Hypoalbuminemia 4
• Low level of ascorbic acid (<2.5 mg/l) 4
• Leucocyte ascorbic acid level reflecting total body store 4

Risk Factors

Patients at risk for vitamin C deficiency include those with:

• Inadequate intake of vitamin C-containing foods 2, 3, 4
• Malabsorptive syndromes 3
• Chronic kidney disease or end-stage renal disease 5
• Restrictive eating habits and food insecurity 3
• Alcohol abuse disorder, psychiatric disorders, and low socio-economic status 2, 3, 4