IX. EFFECTS OF DEFICIENCY IN HUMAN BEINGS 365 



accomplished by folic acid the dose has been exceedingly large, averaging 

 13 mg. per kilogram of body weight per day. 



7. Other Laboratory Tests 



The electrolytes in the plasma, e.g., sodium, potassium, calcium, phos- 

 phorus, and carbon dioxide content, are not disturbed specifically by the 

 scorbutic process. However, debility and severe malnutrition of many 

 scorbutic patients may cause sodium and potassium depletion and met- 

 abolic acidosis. Urea nitrogen and blood sugar levels are not specifically 

 affected, and alkaline phosphatase levels are reported to be normal or 

 low." 



Twenty-four-hour urinary 17-ketosteroid levels are low in normal or sub- 

 normal but in the same range as in most severely malnourished persons; 

 ll-ox\^st€roid levels have not been measured. 



Urobilinogen in urine and stool is increased, and the abnormal amount 

 of bilimbin which appears in the plasma is for the most part of the indirect 

 or slow reacting type. These abnormalities in bile pigment production and 

 excretion are probal)l3' due in part to the hemolysis of extravasated blood. 

 However, the amount of jaundice and bilirubinemia do not correlate well 

 with the number and severity of the ecchymoses, and the suggestion has 

 been made that intravascular hemolysis or an abnormality in pigment 

 utilization may occur also.^^ 



A few erythrocytes usuall}^ are found in the urine and spinal fluid and 

 the stool may give a positive test for occult blood with gnaiac reagent. 

 Frank urinary or gastroenteric tract bleeding or hemorrhages into the 

 brain and subarachnoid space are rare. 



8. The Hematopoietic System 



Most patients with scurvy have anemia. The type and etiology vary. In 

 infancy and childhood the anemia is nsually microcytic and hypochromic, 

 but it may be macrocytic or normocytic normochromic.'^-'**' The hj^po- 

 chromic anemia is due principally to a deficiency of iron in the infant's 

 diet and in the mother's diet during the infant's intra-uterine life. Powdered 

 milk formulas deficient in ascorbic acid are also deficient in iron, and the 

 iron deficiency in the infant whose hemoglobin mass is expanding rapidly 

 takes precedence over all other deficiencies. The large hemorrhages into the 

 tissues, particularly the subperosteal hemorrhages and recent external 

 bleeding, contriluite to the anemia and tend to make it normocytic normo- 

 chromic. Infection, if present, accentuates this tendency. As will be seen 



»8 R. W. Vilter, R. M. Woolford, and T. D. Spies, J. Lab. Clin. Med. 31, 609 (1946). 

 39 W. W. Zuelzer, L. Hutoff, and L. Apt, .4m. J. Diseases Children 77, 128 (1949). 

 « L. G. Parsons and W. C. Smallwood, Arch. Disease Childhood 10, 327 (1935). 



