eMedicine Specialties > Endocrinology > Metabolic Disorders

Scurvy: Treatment & Medication

Author: Lynne Goebel, MD, Professor, Department of Internal Medicine, Marshall University Joan C Edwards School of Medicine
Coauthor(s): Henry Driscoll, MD, Professor, Department of Medicine, Section of Endocrinology, Marshall University School of Medicine
Contributor Information and Disclosures

Updated: Jun 25, 2009

Treatment

Medical Care

Patients should take ascorbic acid at 100 mg 3-5 times a day until total of 4 g is reached, and then they should decrease intake to 100 mg daily.

Alternately, ascorbic acid may be taken at 1 g/d for the first 3-5 days followed by 300-500 mg/d for a week. Then the recommended daily allowance is resumed.

  • Divided doses are given because intestinal absorption is limited to 100 mg at one time.
  • Parenteral doses are necessary in those with gastrointestinal malabsorption.

Diet

  • Foods high in vitamin C include the following.
    • Citrus fruits, especially grapefruits and lemons
    • Vegetables, including broccoli, green peppers, tomatoes, potatoes, and cabbage
  • The recommended daily allowance for vitamin C varies. The current recommendation for adults is 120 mg daily, although a dose of 60 mg daily is all that is required to prevent scurvy. Some experts think the level should be as high as 200 mg daily to match the level present in 5 servings of fruits and vegetables daily, a diet shown to decrease cancer risk.
  • Megadoses of vitamin C have not been shown in clinical trials to reduce viral illnesses such as colds. Large doses of vitamin C, ie, more than 1 g/d, may increase the risk of certain illnesses such as kidney stones, particularly oxalate stones.

Medication

The only effective therapy is vitamin C replacement.

Vitamins

Provide critical cofactor necessary for collagen fibril synthesis.


Ascorbic acid (Vita-C, C-Gram)

Vitamin C for treatment of scurvy.

Adult

100 mg PO qid for 10-14 d, then maintenance dose of at least 60 mg/d PO
Ascorbic acid is well absorbed from the GI tract, but can be given IV/IM in unusual, specific circumstances

Pediatric

Depends on size and physical state

Increases absorption of iron; concurrent administration with warfarin may decrease INR by unknown mechanism

Documented hypersensitivity; caution with impaired renal function

Pregnancy

A - Fetal risk not revealed in controlled studies in humans

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Pregnancy category C when dose exceeds RDA recommendations; high doses can predispose to renal oxalate stones; may result in flushing, headache, nausea, and diarrhea

More on Scurvy

Overview: Scurvy
Differential Diagnoses & Workup: Scurvy
Treatment & Medication: Scurvy
Follow-up: Scurvy
Multimedia: Scurvy
References
Further Reading
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References

  1. Leger D. Scurvy: reemergence of nutritional deficiencies. Can Fam Physician. Oct 2008;54(10):1403-6. [Medline]. [Full Text].

  2. Hampl JS, Taylor CA, Johnston CS. Vitamin C deficiency and depletion in the United States: the Third National Health and Nutrition Examination Survey, 1988 to 1994. Am J Public Health. May 2004;94(5):870-5. [Medline]. [Full Text].

  3. Hercberg S, Preziosi P, Galan P, et al. Vitamin status of a healthy French population: dietary intakes and biochemical markers. Int J Vitam Nutr Res. 1994;64(3):220-32. [Medline].

  4. Mosdol A, Erens B, Brunner EJ. Estimated prevalence and predictors of vitamin C deficiency within UK's low-income population. J Public Health (Oxf). Dec 2008;30(4):456-60. [Medline].

  5. Gan R, Eintracht S, Hoffer LJ. Vitamin C deficiency in a university teaching hospital. J Am Coll Nutr. Jun 2008;27(3):428-33. [Medline].

  6. Biesalski HK. Parenteral ascorbic acid in haemodialysis patients. Curr Opin Clin Nutr Metab Care. Nov 2008;11(6):741-6. [Medline].

  7. Singer R, Rhodes HC, Chin G, et al. High prevalence of ascorbate deficiency in an Australian peritoneal dialysis population. Nephrology (Carlton). Feb 2008;13(1):17-22. [Medline].

  8. Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. Jun 1999;69(6):1086-107. [Medline]. [Full Text].

  9. Fain O. Musculoskeletal manifestations of scurvy. Joint Bone Spine. 2005;72:124-128. [Medline].

  10. Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:484-5.

  11. Johnston CS, Thompson LL. Vitamin C status of an outpatient population. J Am Coll Nutr. Aug 1998;17(4):366-70. [Medline]. [Full Text].

  12. Jukes TH. The prevention and conquest of scurvy, beri-beri, and pellagra. Prev Med. Nov 1989;18(6):877-83. [Medline].

  13. Levine M, Rumsey SC, Daruwala R, et al. Criteria and recommendations for vitamin C intake. JAMA. Apr 21 1999;281(15):1415-23. [Medline].

  14. Olmedo JM, Yiannias JA, Windgassen EB, et al. Scurvy: a disease almost forgotten. Int J Dermatol. Aug 2006;45(8):909-13. [Medline].

  15. Pimentel L. Scurvy: historical review and current diagnostic approach. Am J Emerg Med. Jul 2003;21(4):328-32. [Medline].

  16. Schuman RW, Rahmin M, Dannenberg AJ. Scurvy and the gastrointestinal tract. Gastrointest Endosc. Feb 1997;45(2):195-6. [Medline].

  17. Smith MS. The diagnosis and treatment of scurvy: an historical perspective. J R Nav Med Serv. Summer 1986;72(2):104-6. [Medline].

  18. Toole MJ. Micronutrient deficiencies in refugees. Lancet. May 16 1992;339(8803):1214-6. [Medline].

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Further Reading

Related eMedicine topics:
Celiac Sprue
Celiac Disease
Crohn Disease [Gastroenterology]
Crohn Disease [Pediatrics: General Medicine]
Crohn Disease [Radiology]
Malabsorption
Malabsorption Syndromes
Malnutrition
Scurvy [Dermatology]
Scurvy [Pediatrics: General Medicine]
Scurvy [Radiology]
Sprue
Whipple Disease [Gastroenterology]
Whipple Disease [Neurology]

Clinical guidelines:
Celiac disease. National Institutes of Health (NIH) Consensus Development Panel on Celiac Disease - Independent Expert Panel
Office of Medical Applications of Research (NIH) - Federal Government Agency [U.S.].  2004 Aug 9.  15 pages.  NGC:003830

Guideline for the diagnosis and treatment of celiac disease in children: recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition - Professional Association.  2005 Jan.  19 pages.  NGC:004186

Clinical trials:
Celiac Disease Prevention

Urinary Vitamin C Loss in Diabetic Subjects

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Contributor Information and Disclosures

Author

Lynne Goebel, MD, Professor, Department of Internal Medicine, Marshall University Joan C Edwards School of Medicine
Lynne Goebel, MD is a member of the following medical societies: American College of Physicians, Society of General Internal Medicine, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

Coauthor(s)

Henry Driscoll, MD, Professor, Department of Medicine, Section of Endocrinology, Marshall University School of Medicine
Henry Driscoll, MD is a member of the following medical societies: American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Medical Association, Endocrine Society, Massachusetts Medical Society, Sigma Xi, and West Virginia State Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Stanley Wallach, MD, Executive Director, American College of Nutrition; Clinical Professor, Department of Medicine, New York University School of Medicine
Stanley Wallach, MD is a member of the following medical societies: American Society for Bone and Mineral Research, American Society for Clinical Investigation, American Society for Clinical Nutrition, American Society for Nutritional Sciences, Association of American Physicians, and Endocrine Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS, Professor of Medicine (Endocrinology, Adj), Johns Hopkins School of Medicine; Affiliate Research Professor, Bioinformatics and Computational Biology Program, School of Computational Sciences, George Mason University; Principal, C/A Informatics, LLC
Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Endocrinology, American College of Nutrition, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Informatics Association, American Society for Bone and Mineral Research, American Society of Law Medicine and Ethics, Endocrine Society, and International Society for Clinical Densitometry
Disclosure: Nothing to disclose.

CME Editor

Mark Cooper, MBBS, PhD, FRACP, Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University
Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD, Professor of Medicine, St Louis University School of Medicine
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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