What are the other Names for this Condition? (Also known as/Synonyms)

• Ascorbic Acid Deficiency Disorder
• Scorbutus
• Vitamin C Deficiency Disorder

What is Scurvy? (Definition/Background Information)

• Scurvy is a medical condition that occurs due to deficiency of vitamin C in the diet, usually for a period of 3 months or more. It can result in tender gums, tooth loss, easy bruising, weakness, appetite loss, and muscular pain. It is also known as Vitamin C Deficiency Disorder
• This disorder is more common among populations where the diet is typically lacking vitamin C rich foods (such as fruits and vegetables). Other factors for developing Scurvy include inflammatory bowel diseases, alcoholism, weight-loss diets, and malnutrition. Scurvy is generally uncommon in the developed nations
• Vitamin C supplementation and injections may be required to treat the condition. Including plenty of fresh fruits and vegetables is also a recommended treatment option. If identified and treated promptly, the prognosis is good in many cases. A delayed diagnosis and/or treatment may result in gingivitis, iron-deficiency anemia, and easy fractures due to weak bones

Who gets Scurvy? (Age and Sex Distribution)

Scurvy is observed worldwide in individuals of all ages, in both males and females, across all racial and ethnic groups. It is more common in regions with low intake of vitamin C-rich foods; but, is rare in most well-developed nations of the world.

The following groups are more susceptible to Scurvy:

• Elderly adults
• Alcoholics and chronic smokers
• Individuals on diet devoid of fresh fruits and vegetables
• Infants or children who are on special or vitamin C poor diets
• Malnourished individuals who lack vitamin C in their overall diet
• Individuals coming from poor economic backgrounds

What are the Risk Factors for Scurvy? (Predisposing Factors)

The following are some risk factors that could contribute to the development of Scurvy:

• Absence of vitamin C in the diet for a certain period of time (usually over 3 months)
• A poor-quality diet containing little or no fruits and vegetables
• Anorexia nervosa
• Alcoholism
• Poor dental hygiene
• Gastrointestinal diseases such as malabsorption, inflammatory bowel disease, dyspepsia, and Whipple’s disease
• Individuals who have undergone gastric bypass surgery
• Individuals on dialysis
• Type I diabetes
• Eating only cooked food increases the risk, since vitamin C is heat-labile (meaning that it can be destroyed by heat)
• Individuals undergoing chemotherapy
• Following fad (fanciful) diets
• Self-imposed restrictive diets for weight loss

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting the condition compared to an individual without the risk factors. Some risk factors are more important than others. Not having a risk factor does not conclude that an individual will not get the condition.

What are the Causes of Scurvy? (Etiology)

A deficiency in vitamin C in the diet is the typical cause of Scurvy, since humans cannot produce vitamin C in the body. Vitamin C is a water-soluble nutrient that is not stored in the body. It plays the following role in the body:

• As an antioxidant, it protects the body against damage caused by free radicals
• It plays an important role in the synthesis of collagen. Collagen is a protein that is most abundant in the body. This protein is present in the blood vessels, skin, muscles, and cartilage and is required for the growth and repair of tissues in the body
• Vitamin C helps the body absorb iron from non-heme sources. Non-heme sources constitute plants (vegetables, grains, and nuts), and about 60% of the animal sources

Lack of sufficient vitamin C in the diet therefore interferes with the body’s growth and repair mechanisms, its disease-fighting ability, and absorption of iron, leading to various sigsn and symptoms of the condition.

What are the Signs and Symptoms of Scurvy?

The symptoms of Scurvy usually begin in a few months following vitamin C deficiency in the body; the deficiency may have occurred for a period of 3 months or more. The common signs and symptoms of Scurvy include:

• Weakness and fatigue, paleness
• Sunken eyes, proptosis of the eyeball (protruding eye)
• Dry eyes and mouth
• Tender gums and/or tooth loss; swelling and bleeding from the gums
• Muscular pain and bone pain; aching and swelling in joints
• Loss of appetite, weight loss, inability to gain weight
• Diarrhea
• Increases heart rate, low blood pressure; signs and symptoms associated with heart failure may be noted
• Irritability
• Increases susceptibility to infections (such as to common cold)
• Shortness of breath
• Vitamin C deficiency in pregnant woman can be potentially harmful to the developing fetus

Common skin signs and symptoms of Scurvy include:

• Papules with increased keratosis on the skin
• Reddish discoloration around the hair follicles
• Curly hair that breaks-off easily
• Areas of bleeding on skin causing purpura
• Easy bruising, the re-opening of old wounds or sores; poor wound healing
• Hemorrhage under the nails (splinter hemorrhages)
• Hair loss

How is Scurvy Diagnosed?

Information from the following may be needed to accurately diagnose Scurvy:

• A thorough physical examination and an evaluation of symptoms
• An analysis of the affected individual’s diet
• A blood test to measure the level of vitamin C in blood; leukocyte vitamin C level
• X-rays to check for damage to bones in infants
• Ascorbic acid tolerance test: Determination of urinary levels of vitamin C after 6 hours, after giving 1 gram of oral ascorbic acid to the individual

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule other clinical conditions to arrive at a definitive diagnosis

What are the possible Complications of Scurvy?

Some potential complications that could arise from Scurvy include:

• Anemia: When there is a lack of vitamin C in the diet, it makes it difficult for the body to properly absorb iron from food sources, especially the non-meat forms of iron. This can lead to anemia
• Gingivitis or bleeding gums can potentially lead to heart disease
• Internal bleeding
• Scorbutic dysentery
• Bleeding within the joints
• Easy fractures
• In severe cases, jaundice, convulsions, kidney failure and generalized edema can occur

Death is known to occur, if the condition is severe and is left untreated.

How is Scurvy Treated?

The treatment options for Scurvy include:

• Intake of vitamin supplements; vitamin C can also be administered orally or injected into the body. In most individuals, taking oral vitamin C supplements is adequate treatment
• Intake of foods that contain an abundance of vitamin C. The sources of vitamin C rich fruits and vegetables include:
  • Broccoli and asparagus
  • Black currants
  • Guava
  • Oranges and lemon
  • Papaya
  • Strawberries
  • Grapefruits
  • Cantaloupe
  • Brussels sprouts
  • Spinach, cabbage
  • Sweet peppers and green peppers
  • Sweet potatoes
• It takes several days to weeks of treatment before the signs and symptoms get better. Spontaneous bleeding, if any, gets better within days of starting treatment
• Individuals with Scurvy usually have other vitamin and mineral deficiencies. These are also to be treated

How can Scurvy be Prevented?

Considering the following factors may help prevent the development of Scurvy:

• Eating a healthy, well-balanced diet that contains plenty of fresh fruits and vegetables
• Seeking medical help early, so that the condition does not progress
• Taking vitamin C supplements, per the healthcare professional’s recommendations
• Taking adequate vitamin supplements before and during pregnancy

What is the Prognosis of Scurvy? (Outcomes/Resolutions)

• The prognosis of Scurvy is reported to be good, when the symptoms are recognized early and prompt treatment is provided
• However, if left untreated, the condition can worsen and may even be fatal

Additional and Relevant Useful Information for Scurvy:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/nutrition-and-dietetics/