What is the treatment for scurvy (Vitamin C deficiency)?

Treatment of Scurvy

Initiate oral vitamin C 100 mg three times daily (300-500 mg/day total) for at least one month, and do not delay treatment while awaiting laboratory confirmation if clinical symptoms are present. 1, 2

Immediate Treatment Protocol

Begin treatment immediately when clinical features suggest scurvy, including bleeding gums, petechiae, ecchymoses, perifollicular hemorrhages, "corkscrew" hair, poor wound healing, bone pain, and joint contractures. 1, 2, 3

Standard Oral Repletion Regimens

Choose one of the following evidence-based protocols:

• 100 mg three times daily (300 mg/day total) for 1 month - this is the primary recommended regimen 1, 2
• 500 mg once daily for 1 month - alternative single-dose regimen 1
• 250 mg twice daily for 3 weeks - alternative for severe clinical scurvy 1

Route of Administration

• Oral administration is standard for uncomplicated scurvy 2
• IM, IV, or subcutaneous routes should be used only when malabsorption is suspected or the patient cannot tolerate oral intake 2

Clinical Response Timeline

Expect rapid clinical improvement within 2 weeks, with resolution of skin lesions, improved mobility, and resolution of joint contractures. 3 The patient in the illustrative case showed significant improvement and was discharged mobile with complete resolution of skin lesions after 2 weeks of 500 mg daily oral vitamin C. 3

Maintenance Therapy After Repletion

After completing the 1-month repletion course, transition to maintenance dosing:

• 75-90 mg/day for healthy adults - achievable with one medium-sized orange 1, 2, 3
• 200-500 mg/day indefinitely for high-risk populations, including post-bariatric surgery patients, those with chronic oxidative stress, alcoholism, severe psychiatric illness, or poor dietary habits 1, 2, 4

Special Populations

Pediatric Dosing (Parenteral Nutrition Context)

• Preterm and term infants up to 12 months: 15-25 mg/kg/day 5
• Older children: 80 mg/day 5

Critically Ill Patients with Documented Severe Deficiency

2-3 g/day IV during acute inflammation phase - this is substantially higher than standard scurvy treatment and applies only to critical illness with documented deficiency. 1, 6, 2

Critical Safety Considerations

Contraindications to high-dose vitamin C (>1 g/day):

• Hemochromatosis 1, 6, 2
• G6PD deficiency 1, 6, 2
• Active oxalate kidney stones 1, 2
• Severe renal dysfunction 1, 2

Diagnostic Considerations

Do not delay treatment for laboratory confirmation. 1, 2 Plasma vitamin C levels reflect recent dietary intake rather than tissue stores and are unreliable during inflammation (when CRP >10 mg/L, vitamin C levels decline; when CRP >40 mg/L, normal values are typically not detected). 1, 2

Pathognomonic clinical findings that confirm the diagnosis:

• Perifollicular hemorrhages 2, 3
• "Corkscrew" hair appearance 2, 3
• Gingival bleeding and swelling 2, 3
• Ecchymoses and petechiae 2, 3

Common Pitfalls to Avoid

Do not measure plasma vitamin C levels in acutely ill or inflamed patients - results will be falsely low and misleading. 1, 2 Testing is only recommended for suspected scurvy in stable patients or those with chronic low intake. 1, 2

Do not confuse scurvy treatment with sepsis protocols. Vitamin C is not recommended as routine pharmacotherapy for sepsis, and the Surviving Sepsis Campaign specifically recommends against its use in septic shock. 6, 2

Remember that only 60 mg daily is required to prevent scurvy (the amount in one medium-sized orange), making this disease rare in developed countries but still occurring in high-risk populations including the elderly, alcoholics, those with severe psychiatric illness, low socioeconomic status, and restrictive diets. 3, 7, 4, 8