eMedicine Specialties > Pediatrics: General Medicine > Nutrition

Scurvy: Treatment & Medication

Author: Bradley S Buckler, MD, Fellow in Neonatal-Perinatal Medicine, Medical College of Georgia
Coauthor(s): Anjali Parish, MD, Assistant Professor of Pediatrics, Department of Neonatology, Medical College of Georgia
Contributor Information and Disclosures

Updated: Jul 16, 2009

Treatment

Medical Care

  • Vitamin C administered by mouth or the parenteral route is effective in curing infantile scurvy.
  • 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.

Diet

  • A diet adequate in vitamin C can prevent the development of scurvy. The dietary requirements of vitamin C sufficient to prevent deficiency vary with the age of the individual. The following are the Food and Nutrition Board of the National Academy of Sciences, National Research Council's minimum recommended daily dietary allowances of vitamin C:
    • Infants - 30-40 mg
    • Children and adults - 45-60 mg
    • Pregnant women - 70 mg
    • Lactating mothers - 90-95 mg
  • Food sources rich in vitamin C include the following:
    • Citrus fruits
    • Berries
    • Cantaloupe
    • Broccoli
    • Cauliflower
    • Cabbage
    • Spinach
    • Potatoes
    • Tomatoes

Medication

Vitamins

Vitamins are organic substances required by the body in small amounts for various metabolic processes. Vitamins may be synthesized in small or insufficient amounts in the body or not synthesized at all, thus requiring supplementation. They are classified as either fat soluble or water soluble. Vitamins A, D, E, and K are fat soluble, whereas biotin, folic acid, niacin, pantothenic acid, B vitamins (ie, B-1, B-2, B-6, B-12), and vitamin C are generally water soluble.

Vitamin deficiency may result from an inadequate diet, from increased requirements (eg, pregnancy, lactation), or secondary to disease or drugs. Vitamin supplements are used clinically for the prevention and treatment of specific vitamin-deficiency states.


Ascorbic acid (Cecon, Ce-Vi-Sol, Dull-C)

Ascorbic acid (vitamin C) administered PO or parenterally effectively cures infantile and adult scurvy. Used by the body for collagen synthesis and tissue repair.

Adult

100-200 mg PO q6h for 1 wk

Pediatric

25 mg PO q6h for 1 wk

Large doses interfere with the absorption and metabolism of vitamin B-12; decreases effects of warfarin and fluphenazine; increases aspirin levels

Large doses may precipitate hemolysis in individuals with glucose-6-phosphate dehydrogenase deficiency; large doses are contraindicated in conditions aggravated by acid loading (eg, gout, renal tubular acidosis, cirrhosis, paroxysmal nocturnal hemoglobinuria)

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Large doses can cause renal stones and diarrhea; long-term high intake has been associated with metabolic tolerance/resistance and the expression, either clinically or biochemically, of vitamin C deficiency; for example, scurvy has been reported in infants born to mothers who had taken at least 400 mg/d of vitamin C during the entire pregnancy; healthy adults who take larger doses of vitamin C long term may manifest low serum ascorbic acid levels when they resume normal intake

More on Scurvy

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

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  2. Ratanachu-Ek S, Sukswai P, Jeerathanyasakun Y. Scurvy in pediatric patients: a review of 28 cases. J Med Assoc Thai. Aug 2003;86 Suppl 3:S734-40. [Medline].

  3. Tveden-Nyborg P, Lykkesfeldt J. Does vitamin C deficiency result in impaired brain development in infants?. Redox Rep. 2009;14:2-6. [Medline].

  4. Ragunatha S, Inamadar AC, Palit A, Sampagavi VV, Deshmukh NS. Diffuse nonscarring alopecia of scalp: an indicator of early infantile scurvy?. Pediatr Dermatol. Nov-Dec 2008;25(6):644-6. [Medline].

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  6. Barlow T. On cases described as 'acute rickets' which are probably a combination of scurvy and rickets, the scurvy being essential, and rickets a variable element. Med Chir Trans (London). 1883;66:159-220.

  7. Barness LA. Vitamin C (Ascorbic Acid) (Scurvy). In: Nelson Textbook of Pediatrics. 14th ed. Philadelphia, Pa: W B Saunders Company; 1992:139-41.

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  12. Greene HL. Disorders of the water-soluble vitamin B-complex and vitamin C. In: Textbook of Pediatric Nutrition. 2nd ed. New York, NY: Raven Press; 1993:86-88.

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  15. Kocak M, Akbay G, Eksioglu M. Case 2: sudden ecchymosis of the legs with feelings of pain and weakness. Diagnosis: adult scurvy. Clin Exp Dermatol. May 2003;28(3):337-8. [Medline].

  16. Park EA, Guild HG, Jackson D. The recognition of scurvy with special reference to the early x-ray changes. Arch Dis Child. 1965;4:82-9.

  17. Rosati P, Boldrini R, Devito R. A child with painful legs. Lancet. Apr 16-22 2005;365(9468):1438. [Medline].

  18. Sauberlich HE. Human requirements. Vitamin C status: methods and findings. Ann NY Acad Sci. 1975;258:438-450. [Medline].

  19. Truswell AS. Vitamin C (Ascorbic acid). In: Davidson's Principles and Practice of Medicine. 13th ed. New York, NY: Churchill Livingstone; 1981:107-9.

  20. Wilson LG. The clinical definition of scurvy and the discovery of vitamin C. J Hist Med. 1975;30:40-60. [Medline].

  21. Woodruff CW. Ascorbic Acid-Scurvy. Prog Food Nutr Sci. 1975;1:493-506. [Medline].

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Further Reading

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Keywords

scurvy, vitamin C deficiency, infantile scurvy, Barlow disease, Barlow's disease, Cheadle disease, Cheadle's disease, osteopathia hemorrhagica infantum, scurvy rickets, deficiency of ascorbic acid, impaired collagen synthesis, defective collagen, defective dentine formation, hemorrhaging

hemorrhaging into the gums, subperiosteal hemorrhage, pseudoparalysis, costochondral beading, scorbutic rosary, hyperkeratosis, corkscrew hair, sicca syndrome, whiteline of Frãnkel, treatment, diagnosis

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Contributor Information and Disclosures

Author

Bradley S Buckler, MD, Fellow in Neonatal-Perinatal Medicine, Medical College of Georgia
Disclosure: Nothing to disclose.

Coauthor(s)

Anjali Parish, MD, Assistant Professor of Pediatrics, Department of Neonatology, Medical College of Georgia
Anjali Parish, MD is a member of the following medical societies: American Academy of Pediatrics and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Steven M Schwarz, MD, FAAP, FACN, AGAF, Professor of Pediatrics, Children's Hospital at Downstate, SUNY-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 College of Physician Executives, American Gastroenterological Association, American Pediatric Society, Gastroenterology Research Group, New York Academy of Medicine, North American Society for Pediatric Gastroenterology and Nutrition, and Society for Pediatric Research
Disclosure: TAP Pharmaceuticals Honoraria Speaking and teaching; Curemark, LLC Consulting fee Board membership; Centocor, Inc. Grant/research funds Independent contractor

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

CME Editor

Merrily P M Poth, MD, Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences
Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society
Disclosure: Nothing to disclose.

Chief Editor

Jatinder Bhatia, MBBS, Professor of Pediatrics, Chief, Section of Neonatology, Department of Pediatrics, Medical College of Georgia
Jatinder Bhatia, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Dietetic Association, American Federation for Clinical Research, American Pediatric Society, American Society for Clinical Nutrition, American Society for Parenteral and Enteral Nutrition, New York Academy of Sciences, Society for Pediatric Research, and Southern Society for Pediatric Research
Disclosure: Mead Johnson Consulting fee Consulting; Mead Johnson Honoraria Speaking and teaching; Dey LP Consulting fee Consulting; Dey LP Honoraria Speaking and teaching; Ovation Honoraria Speaking and teaching

 
 
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