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Scurvy Treatment & Management

  • Author: Lynne Goebel, MD; Chief Editor: George T Griffing, MD  more...
 
Updated: Sep 23, 2015
 

Approach Considerations

Because sudden death may occur in patients with scurvy, ensuring adequate vitamin C replenishment in patients with vitamin C deficiency is the hallmark of therapy. Restoration of body stores of vitamin C is essential to achieve complete resolution of symptoms. In most adult patients, provision of 250 mg of vitamin C 4 times a day for 1 week aids in achieving this goal.

Identifying and treating comorbid nutritional deficiencies (eg, iron deficiency anemia, folate deficiency, other vitamin deficiencies) are integral parts of management. Provision of a balanced and liberal diet to meet the nutritional needs of the patient aids in recovery.

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Ascorbic Acid

Orange juice is an effective dietary remedy for curing infantile scurvy and was the standard treatment before the discovery of vitamin C. Upon instituting dietary or pharmacologic treatment, the clinical recovery is impressive. The appetite of the infant is recovered within 24-48 hours. The symptoms of irritability, fever, tenderness upon palpation, and hemorrhage generally resolve within 7 days.

Patients should take oral 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. Alternatively, ascorbic acid may be taken at 1 g/d for the first 3-5 days followed by 300-500 mg/d for 1 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.

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Diet

A diet adequate in vitamin C can prevent the development of scurvy. Foods high in vitamin C include citrus fruits, especially grapefruits and lemons; berries and cantaloupe; and vegetables, including broccoli, spinach, green peppers, tomatoes, potatoes, cauliflower, and cabbage.

The recommended daily allowance for vitamin C varies with the age of the individual. 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.

The following are the Food and Nutrition Board of the National Academy of Sciences and the National Research Council's minimum recommended daily dietary allowances of vitamin C:[31]

  • Infants: 0-6 months, 40 mg; 7-12 months, 50 mg
  • Children: 1-3 years, 15 mg; 4-8 years, 25 mg
  • Males: 9-13 years, 45 mg; 14-18 years, 75 mg; 19-70 years, 90 mg
  • Females: 9-13 years, 45 mg; 14-18 years, 65 mg; 19-70 years, 75 mg
  • Pregnant women: Younger than 18 years, 80 mg; 19-50 years, 85 mg
  • Lactating mothers: Younger than 18 years, 115 mg; 19-50 years, 120 mg

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.

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Contributor Information and Disclosures
Author

Lynne Goebel, MD Professor, Department of Internal Medicine, Joan C Edwards School of Medicine at Marshall University

Lynne Goebel, MD is a member of the following medical societies: American College of Physicians, Society of General Internal Medicine, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Coauthor(s)

Mose July, MD Fellow in Endocrinology, Diabetes and Metabolism, Marshall University School of Medicine

Mose July, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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 Nutrition, American Society for Bone and Mineral Research, International Society for Clinical Densitometry, American College of Endocrinology, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Informatics Association, Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD Professor Emeritus 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, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Additional Contributors

Janet J Wong, MD Consulting Dermatologist, Department of Dermatology, University of Connecticut School of Medicine

Janet J Wong, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Van Perry, MD Assistant Professor, Department of Medicine, Division of Dermatology, University of Texas School of Medicine at San Antonio

Van Perry, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Kathryn Schwarzenberger, MD Associate Professor of Medicine, Division of Dermatology, University of Vermont College of Medicine; Consulting Staff, Division of Dermatology, Fletcher Allen Health Care

Kathryn Schwarzenberger, MD is a member of the following medical societies: Women's Dermatologic Society, American Contact Dermatitis Society, Medical Dermatology Society, Dermatology Foundation, Alpha Omega Alpha, American Academy of Dermatology

Disclosure: Nothing to disclose.

Steven M Schwarz, MD, FAAP, FACN, AGAF Professor of Pediatrics, Children's Hospital at Downstate, State University of New York Downstate Medical Center

Steven M Schwarz, MD, FAAP, FACN, AGAF is a member of the following medical societies: American Academy of Pediatrics, American College of Nutrition, American Association for Physician Leadership, New York Academy of Medicine, Gastroenterology Research Group, American Gastroenterological Association, American Pediatric Society, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Society for Pediatric Research

Disclosure: Nothing to disclose.

Anne Elizabeth Laumann, MBChB, MRCP(UK), FAAD Professor of Dermatology, Chief of General Dermatology, Director of the Collagen Vascular Disorders Clinic, Northwestern University, The Feinberg School of Medicine

Anne Elizabeth Laumann, MBChB, MRCP(UK), FAAD is a member of the following medical societies: American Academy of Dermatology, Association of Professors of Dermatology, British Association of Dermatologists, Chicago Dermatological Society, Chicago Medical Society, Illinois Dermatological Society, Illinois State Medical Society, Medical Dermatology Society, Society for Investigative Dermatology, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Henry Driscoll, MD Farrell Professor of Endocrinology, Chief, Department of Medicine, Section of Endocrinology, Joan C Edwards School of Medicine at Marshall University

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, West Virginia State Medical Association

Disclosure: Nothing to disclose.

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Julia Sanger Minocha, MD Resident Physician, Department of Medicine, Northwestern University, The Feinberg School of Medicine

Julia Sanger Minocha, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, Phi Beta Kappa

Disclosure: Nothing to disclose.

Bradley S Buckler, MD Fellow in Neonatal-Perinatal Medicine, Medical College of Georgia

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Anjali Parish, MD, Kumaravel Rajakumar, MD, and Tarita Thomas, PhD, MBA,to the development and writing of the source articles.

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Anteroposterior radiograph of the lower extremities shows ground-glass osteopenia, a characteristic of scurvy.
Perifollicular hemorrhage.
Periodontal images of the patient taken before periodontal treatment. Extensive gingival overgrowth with severe periodontal inflammation was observed in the maxillary and mandibular arches at the first visit (July, 2008). Image from open access article Omori K, Hanayama Y, Naruishi K, Akiyama K, Maeda H, Otsuka F, Takashiba S. Gingival overgrowth caused by vitamin C deficiency associated with metabolic syndrome and severe periodontal infection: a case report. Clin Case Rep. 2014 Dec; 2(6):286-95.
Treatment protocol for above patient with extensive gingival overgrowth with severe periodontal inflammation in the maxillary and mandibular arches. Image from open access article Omori K, Hanayama Y, Naruishi K, Akiyama K, Maeda H, Otsuka F, Takashiba S. Gingival overgrowth caused by vitamin C deficiency associated with metabolic syndrome and severe periodontal infection: a case report. Clin Case Rep. 2014 Dec; 2(6):286-95.
Periodontal images taken before and after ascorbic acid supplementation. (A) Recurrent gingival overgrowth observed after the second gingivectomy and before ascorbic acid supplementation (September, 2011), (B) images taken after 9 months of ascorbic acid supplementation (June, 2012). The white arrows indicate typical sites of recurrent gingival overgrowth. Image from open access article Omori K, Hanayama Y, Naruishi K, Akiyama K, Maeda H, Otsuka F, Takashiba S. Gingival overgrowth caused by vitamin C deficiency associated with metabolic syndrome and severe periodontal infection: a case report. Clin Case Rep. 2014 Dec; 2(6):286-95.
 
 
 
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