July 2020
Luke Maxfield; Jonathan S. Crane.
Introduction
Scurvy is a clinical syndrome that results from vitamin C deficiency. Tales from pirates and British sailors made the disease infamous. This disease was first reported in 1550 BC when people accurately described the diagnosis and treatment using onions and vegetables. Hippocrates officially termed the disease "ileos ematitis" with the description, “the mouth feels bad; the gums are detached from the teeth; blood runs from the nostrils… ulcerations on the legs; some of these heal… skin is thin.” In the 1700s, James Lind of the British Royal Navy determined the consumption of lemons and oranges led to remission of the disease, and in 1927, the structure of ascorbic factor was published, with the synthesis of ascorbic acid named vitamin C not long after.[1][2][3][4]
The vitamin C pool in the body is usually depleted in 4-12 weeks if one stops the intake of the vitamin. Ascorbic acid is affected by many factors that can impair absorption and its functions. The best way to prevent vitamin C deficiency is to consume fruits and vegetables regularly.
Treatment / Management
Direct replacement of vitamin C is standard, with up to 300 mg daily for children and 500 mg to 1000 mg daily for adults. The endpoint of replacement is one month or upon resolution of clinical sequelae. Alternative treatment regimens for adults include one to 2 g for up to 3 days followed by 500 mg daily for a week followed by 100 mg daily for up to 3 months. In addition to immediate supplementation, educate the patient on lifestyle modifications to ensure adequate intake, and recommend cessation of alcohol, and tobacco use.
In the absence of a deficiency, daily requirements are up to 45 mg per day in children, 90 mg per day for men, 75 mg per day for women, and up to 120 mg per day for women who are lactating.
The key is to treat the primary condition causing scurvy.
