What is the recommended treatment for scurvy?

Treatment of Scurvy

Patients with clinical scurvy should be treated with 250 mg of oral vitamin C twice daily for 3 weeks. 1

Diagnosis and Clinical Presentation

Scurvy is a disease caused by vitamin C deficiency, characterized by:

• Fatigue, weakness, and myalgia
• Arthralgias
• Purpura and bleeding disorders
• Follicular hyperkeratosis and perifollicular hemorrhage
• Gum involvement and dental manifestations (in advanced cases)
• Anemia, hypocholesterolemia, and hypoalbuminemia (nonspecific laboratory findings)

The diagnosis is confirmed by measuring plasma vitamin C levels, with levels below 2 mg/L indicating scurvy 2. However, plasma vitamin C measurement is not recommended during critical illness or severe inflammation due to difficulty in interpretation 1.

Treatment Protocol

First-line Treatment

• Oral vitamin C: 250 mg twice daily for 3 weeks 1
• Alternative regimen: 1 g of vitamin C per day for at least one week 3, 2

Special Considerations

1. Route of administration:

   • Oral administration is preferred for most patients
   • Intravenous administration should be considered in cases of:
     • Malabsorption
     • Critical illness with impaired gut function
     • Need for rapid repletion

2. Dosage adjustments for specific populations:

   • Patients with chronic oxidative stress (diabetes, heart failure, smoking, alcoholism, severe COPD): 200-500 mg/day 1
   • Critical illness: 2-3 g/day intravenously during acute phase of inflammation 1
   • Continuous renal replacement therapy: 2-3 g/day intravenously 1

3. Pediatric dosing:

   • Preterm and term infants up to 12 months on parenteral nutrition: 15-25 mg/kg/day 1
   • Older children on parenteral nutrition: 80 mg/day 1

Dietary Recommendations

In addition to vitamin C supplementation, patients should be advised to consume vitamin C-rich foods:

• Fresh fruits (especially citrus)
• Vegetables
• Promoting access to local markets for fresh produce
• Encouraging local cultivation of vitamin C-containing foods 1

Monitoring and Follow-up

• Clinical improvement should be evident within days to weeks of starting treatment
• Complete resolution of symptoms typically occurs within 7-10 days of vitamin C supplementation 4
• No specific laboratory monitoring is required in most cases, though repeat vitamin C levels may be checked in refractory cases

Prevention

The recommended daily intake of vitamin C varies by authority:

• US RDA: 75 mg/day for women and 90 mg/day for men 1
• European recommendations: 95 mg/day for women and 110 mg/day for men 1, 3
• General recommendation: 50-100 mg/day 3

High-Risk Populations

Special attention should be paid to individuals at higher risk for scurvy:

• Alcoholics 5
• Food faddists and those with restrictive diets
• Isolated elderly individuals
• People with mental illness 4
• Refugees and displaced populations 1

Early recognition and prompt treatment of scurvy are essential to prevent complications and improve quality of life. The treatment is simple, inexpensive, and highly effective when administered appropriately.