A 2-year-old boy who is primarily on a milk based diet presents with a history of swollen bleeding gums, lethargy and pain while moving limbs. Most likely diagnosis of this patient is:

Ans. C. Vitamin C deficiencyVitamin C (Ascorbic acid) is structurally related to glucose. Humans and other primates do not synthesize vitamin C. Dietary sources include vegetables (cauliflower, broccoli, cabbage) and fruits (berries, citrus fruits) Vitamin C functions as a strong reducing agent or in electron transport within biological systems. Ascorbic acid is essential for normal function of leukocytes, fibroblasts, osteoblasts and microsomes and participates in metabolism of carnitine, serotonin and folate. Prolonged vitamin C deficiency results in Scurvy. In infancy, features of scurvy are anorexia, diarrhea, pallor, irritability and increased susceptibility to infections. Subperiosteal hemorrhages and long bone tenderness (Pseudoparalysis of lower limbs) can occur; radiologic abnormalities are frequent. In older children, hemorrhagic signs predominate, with bleeding from gums, conjunctiva and intestinal tract. The diagnosis is made by presence of characteristic physical findings and history of inadequate dietary intake of vitamin C. As in this case the child is on a milk based diet which is deficient in both vitamin C and Iron. Therapy includes 100-200mg of vitamin C orally or parenterally