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Scurvy: Vitamin C Deficiency Symptoms, Causes, and Prevention

Scurvy: The Collagen Deficiency Disease

Scurvy results from severe, prolonged vitamin C (ascorbic acid) deficiency. Vitamin C is an essential cofactor for prolyl and lysyl hydroxylases, which stabilize collagen triple helices. Without it, collagen synthesis fails → connective tissue breakdown.

Clinical Manifestations

  • Mucocutaneous: Gingival swelling, bleeding, ulceration, loosening of teeth (collagen loss in periodontal ligament). Petechiae, perifollicular hemorrhages, corkscrew hairs, poor wound healing.
  • Musculoskeletal: Subperiosteal hemorrhages → bone pain, pseudoparalysis (infants), joint effusions.
  • Systemic: Fatigue, weakness, anemia (impaired iron absorption), edema, depression, cardiac failure (severe).
  • Infantile (Barlow's disease): Irritability, "frog-leg" posture (pain), costochondral beading (scorbutic rosary), impaired bone growth.

Risk Factors

  • Severe dietary restriction (alcoholism, anorexia, food insecurity, fad diets).
  • Malabsorption (IBD, bariatric surgery, short bowel).
  • Increased needs: pregnancy, lactation, burns, surgery, sepsis.
  • Smoking (↑oxidative stress, ↓vit C levels).
  • Infants fed boiled cow's milk without supplementation (heat destroys vit C).

Diagnosis

  • Clinical picture + dietary history.
  • Plasma ascorbate <11 µmol/L (deficient); <23 µmol/L (depleted).
  • Leukocyte ascorbate more reflective of tissue stores.
  • X-ray (infants): ground-glass osteopenia, Trümmerfeld zone, white line of Frankel.

Treatment

  • Adults: 500–1000 mg vitamin C daily (oral/IV) until resolution (days to weeks).
  • Children: 100–300 mg daily.
  • Concurrent iron/folate if anemic.
  • Symptoms improve rapidly: bleeding stops in 24h, bone pain in days.

Prevention

  • RDA: 90 mg/day (men), 75 mg/day (women); smokers +35 mg.
  • Sources: Citrus, berries, kiwi, peppers, broccoli, tomatoes, potatoes.
  • Cooking losses: water-soluble, heat-labile — steam/microwave briefly.

Key Takeaway

Scurvy is entirely preventable and rapidly reversible. It persists in vulnerable populations; clinician awareness ensures timely diagnosis.

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