Scurvy: Causes, Symptoms and Treatments - Medical News Today Scurvy: Causes, Symptoms and Treatments Written by Peter Crosta M.A. 4 36 Scurvy is a disease caused by a diet that lacks vitamin C (ascorbic acid). Patients develop anemia , debility, exhaustion, edema (swelling) in some parts of the body, and sometimes ulceration of the gums and loss of teeth. The name scurvy comes from the Latin scorbutus. We have known about the disease in humans since ancient Greek and Egyptian times. Scurvy commonly is associated with sailors in the 16th to 18th centuries who navigated long voyages without enough vitamin C and frequently perished from the condition. Modern cases of scurvy are extremely rare. Humans cannot synthesize vitamin C, which is necessary for the production of collagen and iron absorption. We have to obtain it from external sources, i.e. from fruits and vegetables, or some foods which are fortified with vitamin C in order to prevent the vitamin C deficiency known as scurvy. Vitamin C deficiency is especially dangerous for the fetus (developing baby in the womb).

Researchers from the University of Copenhagen reported in the journal PLOS ONE that pregnant women with a vitamin C deficiency can have babies whose brain did not develop properly . What causes scurvy? The primary cause of scurvy is insufficient intake of vitamin C (ascorbic acid). This may be due to ignorance, famine, anorexia , restrictive diets (due to allergies, food fads, etc.), or difficulty orally ingesting foods. Historically, scurvy was the result of long sea voyages where sailors did not bring along enough foods with vitamin C. Who gets scurvy? Though scurvy is a very rare disease, it still occurs in some patients - usually elderly people, alcoholics, or those that live on a diet devoid of fresh fruits and vegetables. Similarly, infants or children who are on special or poor diets for any number of economic or social reasons may be prone to scurvy. Symptoms of scurvy Scurvy symptoms may begin with appetite loss, poor weight gain, diarrhea , rapid breathing, fever , irritability, tenderness and discomfort in legs, swelling over long bones, bleeding (hemorrhaging), and feelings of paralysis.

As the disease progresses, a scurvy victim may present bleeding of the gums, loosened teeth, petechial hemorrhage of the skin and mucous membranes (a tiny pinpoint red mark), bleeding in the eye, proptopsis of the eyeball (protruding eye), constochondral beading (beading of the cartilage between joints), hyperkeratosis (a skin disorder), corkscrew hair, and sicca syndrome (an automimmune disease affecting connective tissue). Infants with scurvy will become apprehensive, anxious, and progressively irritable. They often will assume the frog leg posture for comfort when struck with pseudoparalysis. It is common for infants with scurvy to present subperiosteal hemorrhage, a specific bleeding that occurs at the lower ends of the long bones. Diagnosis of scurvy Physicians initially will conduct a physical exam, looking for symptoms described above. Actual vitamin C levels can be obtained by using laboratory tests that analyze serum ascorbic acid levels (or white blood cell ascorbic acid concentration). Sometimes, radiological procedures are ordered for diagnostic purposes and to see what damage scurvy has already done.

Treatments for scurvy Scurvy is treated by providing the patient with vitamin C, administered either orally or via injection. Orange juice usually functions as an effective dietary remedy, but specific vitamin supplements are also known to be effective. How can scurvy be prevented? Scurvy can be prevented by consuming enough vitamin C, either in the diet or as a supplement. Foods that contain vitamin C include: Oranges, lemons, kiwi fruit and strawberries are all excellent natural sources of vitamin C. Oranges Scurvy - Symptoms, Causes, Treatments Scurvy Treatments What is scurvy? Scurvy is a disease that affects the blood vessels, skin, and the body’s healing process, resulting in anemia, hemorrhaging of the skin, and gum disease (gingivitis). Scurvy occurs when your diet is deficient in vitamin C. Scurvy is uncommon in the United States, and those most at risk are older adults and alcoholics suffering from malnutrition. Vitamin C, also known as ascorbic acid, is a water-soluble vitamin, meaning the body neither produces nor stores the vitamin. To maintain good health, vitamin C must be replenished frequently.

If your diet is lacking in fruits and vegetables, you may be at risk of an inadequate level of vitamin C. Conditions that cause malnutrition may be associated with scurvy. Looking for a Doctor? Search Now Find a Nutritionist Near You You may find that the signs and symptoms of scurvy are constant or occur only periodically. The types of symptoms associated with scurvy vary among individuals. Some people with scurvy have only mild symptoms, such as fatigue, while others may develop severe anemia and recurrent infections. The 10 Best Sources of Protein Fortunately, scurvy can be readily and effectively treated with nutritional supplements to resolve deficiencies in vitamin C. Changes in your lifestyle can also reduce your risk of developing scurvy, include limiting alcohol intake, eating a well-balanced diet that includes a variety of fruits and vegetables, not smoking, and always taking all medications and supplements as prescribed. In some cases, if left untreated, scurvy can lead to severe vitamin-deficiency anemia that should be immediately evaluated in an emergency setting.

Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious symptoms, including difficulty breathing or shortness of breath, fainting or change in level of consciousness or lethargy, generalized swelling, muscle pain, uncontrollable bleeding, or rapid heart rate (tachycardia). Seek prompt medical care if you are being treated for scurvy but mild symptoms worsen, recur, are persistent, or give you any reason for concern. Scurvy - Causes - NHS Choices Scurvy - Causes Causes of scurvy Scurvy is caused by a lack of vitamin C in your diet. If your body doesn't have enough vitamin C, it can't produce new collagen (a protein found in many different types of body tissue, including the skin and bones). Without a new supply of collagen, the body's tissue will begin to break down and deteriorate. In the developed world, even if someone has a relatively unhealthy and imbalanced diet, it should provide an adequate supply of vitamin C.

Therefore, for scurvy to develop, there are usually other contributing factors, such as: homelessness complex mental health conditions – such as severe depression or schizophrenia being elderly and unable to maintain a healthy diet – for example, elderly men who've recently been widowed and have little experience of cooking for themselves can sometimes develop scurvy treatments that cause nausea as a side effect, such as chemotherapy , can sometimes result in a person losing their appetite conditions that affect a person's ability to digest food – such as Crohn's disease or ulcerative colitis anorexia nervosa – an eating disorder where a person becomes very concerned about gaining weight and tries to control it by eating as little as possible fad diets smoking – which can reduce the amount of vitamin C absorbed by the body pregnancy or breastfeeding – as the body needs more vitamin C at these times In the UK, scurvy in children is relatively rare. It usually occurs through a combination of parents being on a low income and knowing little about nutrition. For example, in 2009, a case of scurvy was reported in a child whose diet only consisted of bread and jam.

However, delayed or unsuccessful weaning of babies and toddlers to solid food can also lead to scurvy, if these children aren't given the recommended supplementation of vitamins A, C and D from six months of age, or if they're drinking less than 500ml of formula milk. See vitamins for children for more information. Lack of vitamin C Although scurvy is rare in the UK, research has shown that a significant number of people may have a lack of vitamin C. However, it's possible to get a good supply of vitamin C by eating plenty of fruit and vegetables . The good news is that it doesn't have to cost a lot to get your 5 A DAY. Scurvy | DermNet New Zealand DermNet New Zealand Author: Vanessa Ngan, Staff Writer, 2005. What is scurvy? Scurvy is a condition characterised by general weakness, anaemia, gingivitis (gum disease), and skin haemorrhages caused by a prolonged deficiency of vitamin C (ascorbic acid) in the diet. Vitamin C plays a crucial role in the formation of collagen, a major component of connective tissue.

Connective tissue has structural and supportive functions which are indispensable to blood vessels and all tissues within the body. Vitamin C is also important in the proper functioning of the immune system, iron absorption, cholesterol metabolism and other biological activities. Thus scurvy has widespread effects. Who gets scurvy? Scurvy was often seen in sailors on long ocean voyages described from the 15th century onwards. Many men died from the disease until it was discovered that scurvy could be effectively cured and prevented by consuming vitamin C through lemons, oranges and limes. The nickname for British sailors of ‘limey’ derives from the practice of giving British sailors limes. It is thought that scurvy occurs very rarely in modern societies of today as most people have access to year-round fresh fruits and vegetables which are rich sources of vitamin C. However, several groups of people are at risk.

These include: People with chronic malnutrition or those that eat less than 2 servings of fruits/vegetables per day Alcoholics People on peculiar diets or food fads Psychiatric disease (delusions or fear of food, suicide attempt by self-starvation, eating disorders) People with other medical conditions that may prevent the intake and/or absorption of vitamin C Dialysis patients Inflammatory bowel disease (Crohns Disease) Malabsorption disorders Severe dyspepsia Under-developed third world countries where general malnutrition exists. Also, in populations that subsist mainly on cereal grains and without access to fresh fruit or vegetables. What are the signs and symptoms? The diagnosis of scurvy is primarily a clinical one, based on a dietary history of inadequate vitamin C intake and the signs and symptoms described below. Symptoms of scurvy generally develop after at least 3 months of severe or total vitamin C deficiency. Patients initially complain of weakness, fatigue, listlessness and aching limbs, especially in the legs. If left untreated, scurvy can progress to the following more severe problems. Skin problems – one of the first signs of scurvy is the development of perifollicular hyperkeratotic papules, often on the shins.

These appear as reddish/bluish bruise-like spots surrounding hair follicles. The central hairs are twisted like corkscrews that may break easily. The papules may join together to form large areas of palpable purpura or ecchymoses (bruises). Scurvy Extensive purpura Oral problems – gums may swell and become red, soft and spongy. Any slight friction may cause the gums to bleed. Often this results in poor oral hygiene and dental diseases. Musculoskeletal problems – bleeding in the joints causes extreme discomfort and pain. Joints may be swollen and tender and the pain can be so severe that patients cannot walk. Eye problems – patients may complain of dryness, irritation, light intolerance, transient visual blurring and stickiness. Haemorrhaging (bleeding) beneath the conjunctiva and within the optic nerve sheath may also occur. Anaemia – this develops in 75% of patients as a result of blood loss into tissue, altered absorptions and metabolism of iron and folate, gastrointestinal bleeding and intravascular haemolysis. Heart and lung problems – shortness of breath, low blood pressure, and chest pain leading to shock and death.

Treatment and prevention with vitamin C Treatment of scurvy is simply with vitamin C supplements taken orally. The adult dosage is 800-1000 mg/day for at least one week, then 400 mg/day until complete recovery. Children should be given 150-300 mg/day for one month. Some improvement of symptoms is usually noticed within 24 hours. Except for the loss of teeth through dental disease, permanent damage from scurvy does not usually occur. Prevention of scurvy is easily achieved by take the recommended daily intake (RDI) of vitamin C. This is between 30-60 mg/day. By following the “5 servings of fruit and vegetables per day” rule, you will be getting the RDI and maintaining sufficient body stores of vitamin C. Related information References: Book: Textbook of Dermatology. Ed Rook A, Wilkinson DS, Ebling FJB, Champion RH, Burton JL. Fourth edition. Blackwell Scientific Publications. Hirschmann JV, Raugi GJ. Adult scurvy.

Journal of the American Academy of Dermatology 1999;41:895-906 Scurvy | definition of scurvy by Medical dictionary Scurvy | definition of scurvy by Medical dictionary Definition Scurvy is a condition caused by a lack of vitamin C (ascorbic acid) in the diet. Signs of scurvy include tiredness, muscle weakness, joint and muscle aches, a rash on the legs, and bleeding gums. In the past, scurvy was common among sailors and other people deprived of fresh fruits and vegetables for long periods of time. Description Scurvy is very rare in countries where fresh fruits and vegetables are readily available and where processed foods have vitamin C added. Vitamin C is an important antioxidant vitamin involved in the development of connective tissues, lipid and vitamin metabolism, biosynthesis of neurotransmitters, immune function, and wound healing. It is found in fruits, especially citrus fruits like oranges, lemons, and grapefruit, and in green leafy vegetables like broccoli and spinach. In adults, it may take several months of vitamin C deficiency before symptoms of scurvy develop.

Currently, the recommended dietary allowance (RDA) for vitamin C is 50-60 mg/day for adults; 35 mg/day for infants; 40-45 mg/day for children 1-14; 70 mg/day during pregnancy ; and 90-95 mg/day during lactation . The body's need for vitamin C increases when a person is under stress , smoking, or taking certain medications. Causes and symptoms A lack of vitamin C in the diet is the primary cause of scurvy. This can occur in people on very restricted diets , who are under extreme physiological stress (for example, during an infection or after an injury), and in chronic alcoholics. Infants can develop scurvy if they are weaned from breast milk and switched to cow's milk without an additional supplement of vitamin C. Babies of mothers who took extremely high doses of vitamin C during pregnancy can develop infantile scurvy. In children, the deficiency can cause painful swelling of the legs along with fever , diarrhea, and vomiting. In adults, early signs of scurvy include feeling weak, tired, and achy.

The appearance of tiny red blood-blisters to larger purplish blotches on the skin of the legs is a common symptom. Wound healing may be delayed and scars that had healed may start to break down. The gums swell and bleed easily, eventually leading to loosened teeth. Muscle and joint pain may also occur. Diagnosis Scurvy is often diagnosed based on the symptoms present. A dietary history showing little or no fresh fruits or vegetables are eaten may help to diagnose vitamin C deficiency. A blood test can also be used to check the level of ascorbic acid in the body. Treatment Adult treatment is usually 300-1,000 mg of ascorbic acid per day. Infants should be treated with 50 mg of ascorbic acid up to four times per day. Prognosis Treatment with vitamin C is usually successful, if the deficiency is recognized early enough. Left untreated, the condition can cause death . Prevention Eating foods rich in vitamin C every day prevents scurvy. A supplement containing the RDA of vitamin C will also prevent a deficiency. Infants who are being weaned from breast milk to cow's milk need a supplement containing vitamin C. Resources Books Stein, Jay H., editor.

"Ascorbic Acid (Vitamin C) Deficiency." In Internal Medicine. St. Louis: Mosby, 1998. Key terms Ascorbic acid — Another term for vitamin C, a nutrient found in fresh fruits and vegetables. Good sources of vitamin C in the diet are citrus fruits like oranges, lemons, limes, and grapefruits, berries, tomatoes, green peppers, cabbage, broccoli, and spinach. Recommended dietary allowance (RDA) — The daily amount of a vitamin the average person needs to maintain good health. scurvy [skur´ve] a condition due to deficiency of ascorbic acid (vitamin C). Symptoms of infantile scurvy include poor appetite, digestive disturbances, failure to gain weight, increasing irritability, and bruises scattered over the skin. Severe deficiency may cause changes in bone structure. The only adults in the United States likely to develop scurvy are older people who live alone and neglect their diet. In adults, scurvy causes swollen and bleeding gums, looseness of the teeth, rupture of small blood vessels, and small bruises on the skin.

Later symptoms may include anemia, extreme weakness, soreness of upper and lower limbs, tachycardia, and dyspnea. Treatment of scurvy consists of supplying the missing vitamin in prescribed doses, and supplying the proper diet, including fresh fruits and vegetables. When this is done, the symptoms quickly disappear. Fruits and vegetables that are rich in vitamin C include grapefruit, oranges, lemons, limes, cantaloupes, strawberries, raspberries, turnips, raw cabbage, potatoes, and tomatoes. scur·vy (skŭr'vē), A disease marked by inanition, debility, anemia, and edema of the dependent parts; a spongy condition sometimes with ulceration of the gums and loss of teeth, hemorrhages into the skin from the mucous membranes and internal organs, and poor wound healing; due to a diet lacking vitamin C. [fr. A.S.

scurf] scurvy /scur·vy/ (sker´ve) a disease due to deficiency of ascorbic acid (vitamin C), marked by anemia, spongy gums, a tendency to mucocutaneous hemorrhages, and brawny induration of calf and leg muscles. scurvy (skûr′vē) n. A disease caused by deficiency of vitamin C, characterized by spongy and bleeding gums, bleeding under the skin, and extreme weakness. scur′vi·ly adv. [skur′vē] Etymology: Scand, scurfa, scabby severe ascorbic acid deficiency. It is characterized by weakness; anemia; edema; spongy gums, often with ulceration and loosening of the teeth; a tendency to mucocutaneous hemorrhages; and induration of the muscles of the legs. Treatment and prophylaxis of the disease consist of administration of ascorbic acid and inclusion of fresh vegetables and fruits in the diet. Also called scorbutus . See also ascorbic acid, citric acid, infantile scurvy .

Scurvy scurvy Scorbutus, vitamin C deficiency Nutrition A condition characterized by weakness, anemia, gingivitis, skin hemorrhage due to ↓ vitamin C in diet, which rarely occurs in developed nations, but may be seen in older, malnurished adults. See Rebound scurvy , Vitamin C . scur·vy (skŭr'vē) A disease marked by inanition, debility, anemia, edema of the dependent parts, a spongy condition (sometimes with ulceration) of the gums, and hemorrhages into the skin and from the mucous membranes; attributed to a diet lacking sufficient vitamin C. [fr. A.S. scurf] (skur've) [L. scorbutus] SCURVY A disease caused by inadequate intake of ascorbic acid, whose symptoms include fatigue; skin, joint, and gum bleeding; impaired wound healing; dry skin; lower extremity edema; follicular hyperkeratosis; and coiling of body hairs. It is rare in Western nations, where it is found primarily among alcoholics, the chronically mentally ill, and the socially isolated.

It can be prevented with regular consumption of fruits and vegetables, foodstuffs that provide a rich source of dietary vitamin C. See: illustration infantile scurvy A form of scurvy that sometimes follows the prolonged use of condensed milk, sterilized milk, or proprietary foods that do not contain supplementary vitamin C. Symptoms This condition is characterized by anemia, pseudoparalysis, thickening of the bones from subperiosteal hemorrhage, ecchymoses, nonpitting edema, and a tendency toward fractures of the epiphyses. Ascorbic acid deficiency symptoms caused by discontinuation of megadoses of vitamin C. scurvy A deficiency disease caused by an inadequate intake of vitamin C (ascorbic acid). This vitamin C is needed for the formation of stable COLLAGEN ; deficiency leads to weakness of small blood vessels and poor healing of wounds, and spontaneous bleeding occurs into gums, skin, joints and muscles. Treatment with large doses of ascorbic acid is rapidly effective. scurvy a condition in which the blood capillary walls become fragile, leading to excessive bleeding and anaemia, spongy gums with tooth loss, impaired wound healing and eventually death.

Scurvy is due to a lack of ASCORBIC ACID in the diet, normal health being restored by administration of fresh fruits, particularly citrus fruits. English sailors on board ocean-going ships of the 18th and 19th centuries were supplied with citrus fruits to prevent scurvy, this habit giving them the nickname ‘limeys’. scurvy ; vitamin C deficiency severe, long-term, chronic lack of dietary vitamin C; characterized by chronic tiredness, debility, anaemia, dependent oedema, gum ulceration, skin and mucous membrane haemorrhages, and the tendency for healed wounds to break open scur·vy (skŭr'vē) Disease marked by inanition, debility, anemia, and edema of dependent parts; sometimes causes gum ulceration and loss of teeth; due to a diet lacking vitamin C. [fr. A.S. scurf] scurvy (skur´vē), n (scorbutus), a condition resulting from an ascorbic acid deficiency that is severe enough to desaturate the tissues.

The development and manifestations depend on tissue storage of ascorbic acid and factors that influence the rate at which it is used in or released from the tissues. Manifestations of frank scurvy include weakness, poor wound healing, anemia, and hemorrhage under the skin and mucous membranes. Presence or severity of gingival changes is directly related to the presence of local irritants such as calculus. In a severe form and in infantile scurvy, painful subperiosteal hemorrhages occur. Scurvy. scurvy, infantile (Barlow's disease, Cheadle's disease, Moeller's disease), n a nutritional disease of infants caused by a deficiency of vitamin C in the diet. It has the same symptoms as scurvy does in adults. scurvy, land, Scurvy: Background, Pathophysiology, Etiology Pathophysiology Overview Background Scurvy is a state of dietary deficiency of vitamin C (ascorbic acid). The human body lacks the ability to synthesize and make vitamin C and therefore depends on exogenous dietary sources to meet vitamin C needs. Consumption of fruits and vegetables or diets fortified with vitamin C is essential to avoid ascorbic acid deficiency.

Although scurvy is uncommon, it still occurs and can affect adults and children who have chronic dietary vitamin C deficiency (see the image below). Anteroposterior radiograph of the lower extremities shows ground-glass osteopenia, a characteristic of scurvy. See 21 Hidden Clues to Diagnosing Nutritional Deficiencies , a Critical Images slideshow, to help identify clues to conditions associated with malnutrition. Next: Pathophysiology Humans, other primates, and guinea pigs are unable to synthesize L-ascorbic acid (vitamin C); therefore, they require it in their diet. [ 1 ] The enzyme, L-gluconolactone oxidase, which would usually catalyze the conversion of L-gluconogammalactone to L-ascorbic acid, is defective due to a mutation or inborn error in carbohydrate metabolism. The total body pool of vitamin C is approximately 1500 mg. The absorbed vitamin is found ubiquitously in body tissues, with the highest concentrations in glandular tissue and the lowest concentrations in muscle and stored fat. Ascorbic acid is metabolized in the liver by oxidation and sulfation.

The renal threshold for excretion by the kidney in urine is approximately 1.4 mg/100 mL plasma. Excess amounts of ascorbic acid are excreted unchanged or as metabolites. When body tissue or plasma concentrations of vitamin C are low, excretion of the vitamin is decreased. Scurvy occurs after vitamin C has been eliminated from the diet for at least 3 months and when the body pool falls below 350 mg. One study identified a genetic polymorphism of the human plasma protein haptoglobin, Hp 2, that may be an important non-nutritional modifying factor in the pathogenesis of vitamin C deficiency. The Hp 2-2 polymers are less efficient inhibitors of hemoglobin-driven oxidative stress, leading to ascorbic acid depletion. The Hp 2-2 phenotype is present in 35% of whites and 50% of South Asians and East Asians and may help identify patients who are more prone to develop clinically significant vitamin C deficiency. [ 2 ] Vitamin C functionality Vitamin C is required as a redox agent, reducing metal ions in many enzymes and removing free radicals. In this capacity, it protects DNA, protein, and vessel walls from damage caused by free radicals.

Vitamin C is functionally most relevant for the triple-helix formation of collagen; a vitamin C deficiency results in impaired collagen synthesis. The typical pathologic manifestations of vitamin C deficiency, including poor wound healing, are noted in collagen-containing tissues and in organs and tissues such as skin, cartilage, dentine, osteoid, and capillary blood vessels. Pathologic changes in affected children and adults are a function of the rate of growth of the affected tissues; hence, the bone changes are often observed only in infants during periods of rapid bone growth. Defective collagen synthesis leads to defective dentine formation, hemorrhaging into the gums, and loss of teeth. Hemorrhaging is a hallmark feature of scurvy and can occur in any organ. Hair follicles are one of the common sites of cutaneous bleeding. The bony changes occur at the junction between the end of the diaphysis and growth cartilage. Osteoblasts fail to form osteoid (bone matrix), resulting in cessation of endochondral bone formation. Calcification of the growth cartilage at the end of the long bones continues, leading to the thickening of the growth plate. The typical invasion of the growth cartilage by the capillaries does not occur.

Preexisting bone becomes brittle and undergoes resorption at a normal rate, resulting in microscopic fractures of the spicules between the shaft and calcified cartilage. With these fractures, the periosteum becomes loosened, resulting in the classic subperiosteal hemorrhage at the ends of the long bones. Guidelines for the evaluation of fractures in infants and young children have been established. [ 3 ] Intra-articular hemorrhage is rare because the periosteal attachment to the growth plate is very firm. Although the clinical manifestations are unclear, vitamin C is a cofactor in the metabolism of tyrosine and cholesterol and the synthesis of carnitine, neurotransmitters (eg, norepinephrine), peptide hormones, corticosteroids, and aldosterone. Vitamin C also affects hematopoiesis by enhancing the absorption of iron from the small intestine by reducing dietary iron from the ferric form to the ferrous form. This may contribute to the anemia seen with vitamin C deficiency, in which the availability of intracellular iron is reduced. Vitamin C is also necessary to convert folic acid to its active metabolite, folinic acid.

Previous Next: Etiology Scurvy is caused by a prolonged dietary deficiency of vitamin C. Humans obtain 90% of their intake of vitamin C from fruits and vegetables, and cooking these sources decreases vitamin C content 20-40%. The US Food and Drug Administration (FDA) recommends a daily dietary allowance of vitamin C of 75 mg for women and 90 mg for men. The body's pool of vitamin C can be depleted in 1-3 months. Ascorbic acid is prone to oxidation in vivo, and body stores are affected by environmental and lifestyle factors (eg, smoking), biological conditions (eg, inflammation, iron excess), and pathologic conditions (eg, malabsorption) that may alter its oxidation.

Risk factors for vitamin C deficiency include the following: [ 4 ] Babies who are fed only cow's milk during the first year of life Alcoholic individuals [ 1 ] and those who conform to food fads Elderly individuals who eat a tea-and-toast diet; retired people who live alone and those who eat primarily at fast food restaurants Economically disadvantaged persons, who tend to not purchase foods high in vitamin C (eg, green vegetables, citrus fruits) [ 5 ] Refugees who are dependent on external suppliers for their food and have limited access to fresh fruits and vegetables Cigarette smokers: These individuals require an increased intake of vitamin C because of lower vitamin C absorption and increased catabolism Pregnant and lactating women and those with thyrotoxicosis: These individuals require an increased intake of vitamin C because of increased utilization People with anorexia nervosa or anorexia from other diseases such as acquired immunodeficiency syndrome (AIDS) or cancer [ 6 ] People with type 1 diabetes have increased vitamin C requirements, as do those on hemodialysis and peritoneal dialysis [ 7 , 8 ] People with disease of the small intestine such as Crohn, Whipple, and celiac disease, as well as

 after gastric bypass surgery, [ 9 ] because vitamin C is absorbed in the small intestine Individuals with iron overload disorders - These may lead to renal vitamin C wasting Other factors that may lead to vitamin C deficiency include ignorance (eg, boiling of fruit juices), restrictive diets imposed by food allergies, and neurodevelopmental disabilities associated with compromised oral intake of foods.

A case report of vitamin C deficiency in a patient on coumadin raises the possibility of risk in the vitamin K–restricted diet, since overlap exists in foods containing vitamin K and vitamin C. [ 10 ] Recent evidence shows that iron is important in the absorption of vitamin C, and iron deficiency may lower the expression of the sodium-dependent vitamin C transporter in intestinal cells, leading to vitamin C deficiency. [ 11 ] Besides poor diet and anorexia in cancer patients, another mechanism of vitamin C deficiency has been proposed. In a study of cancer patients with adequate daily intake but low serum vitamin C levels, authors proposed increased use of vitamin C possibly to scavenge lipid peroxides or vitamin C sequestration by tumor cells. [ 12 ] Previous Epidemiology United States statistics Data from the National Health and Nutrition Examination Survey (NHANES 2003-2004) that assessed the prevalence of vitamin C deficiency in the United States among a sample of 7277 children and adults (older than age 6 y) found that men aged 20-39 and those older than 60 years had a higher prevalence of deficiency than similarly aged women.

Overall, 8.2 % of men and 6% of women (7.1% overall prevalence) were deficient in vitamin C, which is decreased from the NHANES 1994, which showed 14% of men and 10% of women deficient. [ 13 ] NHANES 2005-2006 showed a lower prevalence of 3.6% of vitamin C deficiency among men and women older than 6 years. [ 14 ] Patients at risk include those with chronic malnutrition, who are elderly or alcoholic, who subsist on diets devoid of fresh fruits and vegetables, and men who live alone (widower scurvy). Infants and children on restrictive diets because of medical, economic, or social reasons are at risk for scurvy. Occurrence of scurvy is uncommon in those younger than 7 months, although infants fed evaporated or condensed milk formulas may develop this disease. If a mother has an adequate diet, breast milk contains sufficient vitamin C for a baby's needs. Commercially available formulas and many prepared fruit juices are fortified with vitamin C.

Other reported cases include people with monotonous or peculiar diets, including patients undergoing dialysis as well as those with cognitive disorders, [ 15 , 16 ] psychiatric illnesses, [ 17 ] malabsorption, inflammatory bowel disease , cancer chemotherapy, Whipple disease , or dyspepsia (those who avoid acidic foods). International statistics The international occurrence of scurvy is unknown. Scurvy is a problem when general malnutrition exists, as in some impoverished, underdeveloped third world countries. Scurvy also occurs in epidemic proportions in international refugee camps and in populations that subsist mainly on cereal grains. A study of nonhospitalized patients in Paris found that 5% of women and 12% of men were deficient [ 18 ] ; in those older than 65 years, this proportion increased to 15% of women and 20% of men.

In a case series from Thailand that reviewed 28 cases of scurvy in infants and children (10 mo to 9 y and 7 mo; median age, 29 mo) hospitalized over a 7-year period (1995-2002), investigators noted prolonged consumption of heated milk (ultra-high temperature [UHT] milk) and inadequate intake of vegetables and fruits were the risk factors for the development of scurvy. [ 19 ] In tests of plasma vitamin C levels in the low-income/materially deprived population of the United Kingdom, carried out between 2003 and 2005 (433 men; 876 women), the Low Income Diet and Nutrition Survey found evidence of vitamin C deficiency in an estimated 25% of men and 16% of women. [ 5 ] Another 20% of the study population had vitamin C levels in the depleted range. According to the report, predictors of plasma vitamin C levels at or below the depleted range include being male, having a low dietary intake of vitamin C, not taking vitamin supplements, and smoking.

[ 5 ] A study of healthy elderly (age 70-75 y) persons living in Padua, Italy took a baseline and 10-year follow-up dietary history and found vitamin C deficiency rose over the 10-year span, from 3-6% in men and 2.3-4.5% in women, which led the authors to recommend multivitamin supplementation in healthy elderly persons. [ 20 ] Race, sex, and age differences in incidence According to NHANES 2004, non-Hispanic white men (11.8%) (had a slightly increased risk of vitamin C deficiency compared with non-Hispanic black men (8.9%) and Mexican American men (7.7%). [ 13 ] Similarly, the non-Hispanic white women (8.2%) had higher rates of vitamin C deficiency compared with non-Hispanic black women (5%) and Mexican American women (4.2%). Mexican American males and females had a lower risk of vitamin C deficiency probably because the traditional Mexican diet is rich in chilies, tomatoes, and squashes, which are high in vitamin C.

[ 13 ] Some studies show vitamin C deficiency to be more common among men, whereas others show equal distribution among men and women. NHANES 2004 shows slightly higher prevalence for men (8.2%) than for women (6%). NHANES 2007-2008 data showed that among American males older than 20 years, the daily intake was 26 mg higher than for females. In fact, teenage females had the lowest intake, followed by preadolescent females and women in their sixties. [ 21 ] Although scurvy can occur at any age, the incidence of scurvy peaks in children aged 6-12 months who are fed a diet deficient in citrus fruits or vegetables as well as in elderly populations, who sometimes have "tea-and-toast" diets deficient in vitamin C. Scurvy is uncommon in the neonatal period. Previous Next: Prognosis Typically, scurvy carries an excellent prognosis if diagnosed and treated appropriately.

Manifestations of scurvy, including the following, tend to dramatically improve, resolving within weeks, if adequate oral vitamin C is given in daily doses to recoup body stores: Spontaneous bleeding stops within 1 day Muscle and bone pain abate quickly Bleeding and sore gums heal in 2-3 days Ecchymoses heal within 12 days In advanced scurvy, serum bilirubin normalizes in less than 1 week, and anemia is corrected in less than a month. Complications The predominant morbidity associated with this disease is a result of hemorrhage into various tissues and depends on the site of involvement. Subperiosteal hemorrhages cause pain and tenderness, resulting in pseudoparalysis. Loss of function at the site of the hemorrhage and anemia are typical sequelae of the hemorrhages observed in scurvy. Subperiosteal hemorrhage in the tibia and femur causes excruciating pain. Laboratory data suggest that the neonatal brain is particularly susceptible to vitamin C deficiency and that this condition may adversely affect early brain development.

[ 22 ] Until minimal daily requirements of vitamin C were supplied, scurvy plagued prolonged naval voyages and military campaigns as personnel succumbed to its devastating effects. Lethargy, fatigue, and hemorrhagic manifestations of impaired collagen synthesis affecting oral, ophthalmic, musculoskeletal, cardiac, and gastrointestinal structures and functions incapacitated or killed more people than enemy action in many cases. Previous 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 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. Health& - Scurvy Scurvy Content What is scurvy? Scurvy is a condition caused by prolonged deficiency of vitamin C and is characterised by general weakness, gum disease (gingivitis), anaemia and skin problems including bleeding into the skin.

Vitamin C is not produced by the body and therefore must come from the diet. Vitamin C is found in fresh fruits and vegetables. Many years ago, scurvy was associated with sailors and pirates as fruit and vegetables would perish during long sea voyages. Scurvy is not as common now, as most people have access to fresh fruit and vegetables, or supplements all year round. However, it is still possible to get scurvy if you are malnourished and lack vitamin C. Anaemia A deficiency in red blood cells or haemoglobin in the body. Gum disease A chronic, progressive disease of the gums caused mainly by bacteria and poor oral hygiene. Early stages are generally asymptomatic, with the advanced stages characterised by loss of gum tissue, supporting bone and eventual loss of teeth. Vitamin C A water-soluble vitamin essential for the formation of connective tissue. It also aids in fighting bacterial infections. Also known as ascorbic acid. Causes Scurvy is caused by a severe deficiency in vitamin C and symptoms usually appear after about three months. Vitamin C is not produced by the body and therefore must come from the diet.

Severe deficiency in vitamin C can be caused by malnutrition where there are limited fruit and vegetables consumed, or in medical conditions that prevent the absorption of vitamin C. A lack of vitamin C in the diet can affect many of the body's processes including collagen formation, which is used throughout the body to strengthen skin, blood vessels and bones. Collagen is also important in wound healing. Other processes affected by a lack of vitamin C include decreased iron absorption and the ability to fight infection . Swollen and reddened gums caused by scurvy. Collagen A connecting surface or tissue between two bones. Vitamin C A water-soluble vitamin essential for the formation of connective tissue. It also aids in fighting bacterial infections. Also known as ascorbic acid. Methods for diagnosis Your doctor can make a diagnosis of scurvy after evaluating your dietary habits and performing a blood test to check vitamin C levels. An X-ray of sore joints or bones to check for bone thinning, which is commonly seen in people with scurvy, may also be performed. Blood test During a blood test, blood can be drawn using a needle or by a finger prick. Your blood can then be analysed to help diagnose and monitor a wide range of health conditions.

Joints A connecting surface or tissue between two bones. X-ray A scan that uses ionising radiation beams to create an image of the body’s internal structures. Vitamin C A water-soluble vitamin essential for the formation of connective tissue. It also aids in fighting bacterial infections. Also known as ascorbic acid. Types of treatment Scurvy is treated by increasing the amount of vitamin C in your diet. This can be in the form of fruits, particularly citrus fruits including oranges, lemons and limes. Vegetables including spinach, cabbage, capsicum and broccoli are also high in vitamin C. To aid your treatment, your doctor may suggest that you take vitamin C supplement tablets for a short period. With effective treatment, symptoms including bleeding into the skin and gums will stop within one to two days. Aching limbs and tender joints may take a few weeks to heal. As part of the treatment process, it is important to manage any underlying conditions that are causing your vitamin C deficiency and scurvy. Many fresh foods including fruit and vegetables contain vitamin C. Joints A connecting surface or tissue between two bones. Vitamin C A water-soluble vitamin essential for the formation of connective tissue. It also aids in fighting bacterial infections.

Also known as ascorbic acid. Potential complications Complications of scurvy can be serious, including anaemia , heart and lung problems, shock and death. Scurvy can also affect bone growth in newborns and children. A deficiency in vitamin C causes growth plates in bones to harden prematurely, leading to the stunting of height. Iron deficiency may occur in people with scurvy. This is because vitamin C is required for the absorption of iron from your diet. Your iron levels may be measured by a blood test while being tested for scurvy. Anaemia A life-threatening condition in which the organs and other tissues do not receive adequate blood flow. Vitamin C A water-soluble vitamin essential for the formation of connective tissue. It also aids in fighting bacterial infections. Also known as ascorbic acid. Prognosis Scurvy is a condition caused by a prolonged deficiency in vitamin C , but is easily treated by increasing the amount of vitamin C in your diet. The outlook is positive, with symptoms subsiding within days to weeks with generally no long-lasting effects. Vitamin C A water-soluble vitamin essential for the formation of connective tissue. It also aids in fighting bacterial infections. Also known as ascorbic acid.

Prevention It is possible to prevent scurvy by having enough vitamin C in the diet. It is best to eat plenty of fresh fruit and vegetables, as they not only contain vitamin C, but many other nutrients to keep you healthy. Vitamin C supplements are also available if you are not getting enough from your diet. Vitamin C A water-soluble vitamin essential for the formation of connective tissue. It also aids in fighting bacterial infections. Also known as ascorbic acid. Share this article Scurvy - symptoms, causes, diagnosis, Scurvy treatment Scurvy Print Scurvy is possibly the oldest known nutritional disease, having been described in medical writings as early as 400 B.C. It is a deficiency disorder that is caused by a lack of vitamin C, or ascorbic acid , in the diet. It is also called vitamin C deficiency or scorbutus. Vitamin C is a very important anti-oxidant that is required for the production of collagen, which is necessary for healthy development of tissues, for the functioning of the immune system, and for the healing of wounds. It is found in certain fruits and vegetables, especially citrus fruits, and green leafy vegetables such as spinach and broccoli.

It was once common in sailors and soldiers, who were away from sources of fresh fruits and vegetables for long periods of time; though it was known that scurvy was nutrition-related, it wasn’t until the 20th century that the exact cause of it was identified. In contemporary times, scurvy is rare in countries where fresh fruits and vegetables are easily accessible, and where vitamin C is added to some foods. SCURVY SYMPTOMS Symptoms of scurvy usually begin to appear about one to three months after the intake of vitamin C has stopped. Scurvy is characterized by tiredness, weakness in the muscles, fainting, aches in the joints and muscles, a rash on the legs , hair growing in a spiral pattern, anemia , and bleeding gums. In children, it presents as painful swelling of the legs, as well as fever , diarrhea , and vomiting . Adult symptoms include malaise, as well the appearance of spots that can appear as tiny red blood blisters to large purplish blotches on the skin of the legs. Gums may swell and bleed easily, turn blue and bruised, and eventually the teeth are loosened.

Other symptoms can include irritability, pain in the legs, paralysis, swelling, lung and kidney problems, and hemorrhaging. If the progress of scurvy is not halted, it will result in death. SCURVY CAUSES Scurvy is primarily caused by a lack of vitamin C in the diet. In babies, scurvy can develop if they are weaned from breast milk to cow’s milk and are not given a vitamin C supplement. It can also occur in babies whose mothers took high doses of vitamin C during pregnancy. Stress, either emotional or physiological, also contributes to scurvy. Image: Scurvy SCURVY DIAGNOSIS Scurvy is usually diagnosed visually, by evaluating the symptoms present. A dietary history may be taken, in which you tell your doctor about your diet, so that a vitamin C deficiency can be discerned. In some cases, a blood test can be given to test the level of ascorbic acid in the blood. Sometimes a dermatologist must be consulted to evaluate the different spots on the skin that can be caused by scurvy or may be a symptom of something else, and an internal medicine specialist can evaluate other symptoms that may affect the internal organs.

SCURVY RISK FACTOR In general, those who do not get enough vitamin C in their diets are at risk for scurvy. This includes people from populations where malnutrition is a threat, and it can also include children and teenagers in developed countries. Babies whose mothers did not have sufficient nutrition during pregnancy and babies who were premature are at high risk, and scurvy is one of the most serious illnesses affecting American teenagers in the present day. It is also a risk for people who drink heavily and for elderly populations that have nutrition deficiencies. Others at risk are those who are taking oral contraceptives, those who are pregnant, breastfeeding, those with inflammatory diseases or burns, those who have undergone surgery, those who are exposed to excessive heat or cold, those who are in dialysis, those who have other nutritional deficiencies, and those who live in high traffic areas where there are high levels of carbon monoxide. The worst complication of scurvy is death. Scurvy can cause cardiac failure, both in infants and adults. It can cause hemorrhaging into various tissues that results in death, and also cause low energy, depression , and excruciating pain. If damage from scurvy does occur, it is irreversible.

SCURVY TREATMENT The treatment for scurvy is simply to make up for the deficiency that caused the illness in the first place. Adults should be given 300 to 1000 milligrams of vitamin C every day until the scurvy is resolved. For infants, the dosage should be about 50 milligrams, three or four times a day. If scurvy is treated, people usually recover, but it is dangerous to leave it untreated. Scurvy can be prevented by eating a healthy diet, rich in vitamin C, which would include fresh fruits and vegetables, including grains, legumes, oranges, lemons, limes, guavas, strawberries, papaya, olives, grapefruit, blackcurrants, tomatoes, broccoli, kiwi fruit, sprouts, cantaloupe, spinach, green peppers, potatoes and sweet potatoes, milk, liver , kidney, fish and cabbage. It is also recommended that you take a vitamin C supplement in order to insure that you are getting enough of it to keep you healthy. Babies, especially those who are being weaned from breast milk, should also be given a supplement.

There are also certain medications that can be used in the treatment of severe scurvy. Some of these include high level ascorbic acid supplements such as Ascor, Ascot, Betac, Cecon, Cemill, or Protexin. There are many natural or home remedies that can be effective in treating scurvy, in addition to vitamin C supplements. Indian gooseberry is known to be very effective, and is, in fact, the richest known source of vitamin C. Lime and lemon, as has been mentioned, is effective, and should be drunk with water, in a solution sweetened with honey. Another fruit that is high in ascorbic acid content is the mango, and mango powder has an even higher vitamin C content than limes. Potatoes are comprised of almost 20% vitamin C content, and history has shown that when potato crops flourished, scurvy did not, but when potato crops failed, scurvy spread rapidly. The leaves of the jaundice plant are also high in ascorbic acid and can be boiled and the juice drunk to treat scurvy.

Causes of Scurvy - RightDiagnosis.com Causes of Scurvy Related cause information List of causes of Scurvy Following is a list of causes or underlying conditions (see also Misdiagnosis of underlying causes of Scurvy ) that could possibly cause Scurvy includes: Inadequate diet Homelessness Scurvy Causes: Risk Factors The following conditions have been cited in various sources as potentially causal risk factors related to Scurvy: more risk factors » Scurvy: Related Medical Conditions To research the causes of Scurvy, consider researching the causes of these these diseases that may be similar, or associated with Scurvy: Defective collagen Scurvy: Causes and Types Causes of Broader Categories of Scurvy: Review the causal information about the various more general categories of medical conditions: more types...» Scurvy as a complication of other conditions: Other conditions that might have Scurvy as a complication may, potentially, be an underlying cause of Scurvy. Our database lists the following as having Scurvy as a complication of that condition: Vitamin C deficiency Scurvy as a symptom: Conditions listing Scurvy as a symptom may also be potential underlying causes of Scurvy.

Our database lists the following as having Scurvy as a symptom of that condition: Vitamin C deficiency Related information on causes of Scurvy: As with all medical conditions, there may be many causal factors. Further relevant information on causes of Scurvy may be found in:

Question: Scurvy is caused by a deficiency of what?
Answer: Vitamin C