An Overview of Scurvy

Think scurvy is a thing of the past that only affected pirates?  Think again.  Although it is not common, scurvy is still occurring even in a developed country like the United States.

Scurvy is a medical condition caused by vitamin C (also known as ascorbic acid) deficiency that results in a disorder of the connective tissues.

Symptoms usually start after vitamin C has been eliminated from the diet for at least three months. Initially, the symptoms are vague and worsen over time.  

• Fatigue
• Loss of appetite
• Poor weight gain
•  Leg pain
• Swelling over long bones
• Bleeding particularly bleeding of gums and petechiae (tiny bleed into the skin)
• Thickening of the skin
• Pseudoparalysis: Unable to move secondary to pain or discomfort, not an actual inability to move the limb

People who are a high risk of malnutrition, like the elderly, homeless, alcoholics, and people with mental illness, are at highest risk of developing scurvy.  

Vitamin C is an important component of many processes in the body.  

Most importantly, Vitamin C is a cofactor for an enzyme required in the formation of collagen.  Collagen is a protein that makes up connective tissues like skin, blood vessels, tendons, ligaments, bones, and cartilage.  The bulk of the issues with Vitamin C deficiency result from decreased collagen formation. 

• Defective bone formation: Bones become fragile and bleeding can occur, particularly at ends of bones.  This is generally seen in infants due to rapid bone growth. 
• Defective tooth formation: This leads to loss of teeth and bleeding of the gums. 
• Bleeding: Collagen is a connective tissue required in blood vessel formation.  Without the correct amount of collagen, capillaries (small blood vessels) can become fragile and lead to bleeding. Hair follicles are a common site of bleeding. 
• Anemia: Vitamin C enhances the absorption of iron.  Lack of vitamin C may reduce the availability of iron leading to anemia.

To be diagnosed accurately, scurvy must be suspected.  Because it starts with vague symptoms, this may not be high on the list of possible diagnoses initially.  Many patients present with symptoms of bleeding and undergo a workup for a possible bleeding disorder.  Vitamin C levels are not commonly performed during initial workup of a bleeding disorder as it is not a common cause of bleeding.  

Diet history is a crucial piece of the diagnostic work-up.  Scurvy can be diagnosed based on symptoms and diet history consistent Vitamin C deficiency without lab work.  Blood levels of vitamin C can be sent but these can be difficult to interpret.   

Treatment is as simple as vitamin C supplementation.  Children are usually treated with 100 mg a couple times a week initially, then daily.  

Adult dosing varies widely from 300 mg to 1000 mg daily.  Some symptoms like fatigue can resolve within 24 hours and others may take weeks.  

Scurvy can be prevented by ingesting an appropriate amount of vitamin C in your diet.  Vitamin C rich foods include oranges, lemons, tomatoes, strawberries, and broccoli.

During long expeditions, pirates went long periods of time without fruits and vegetables containing Vitamin C.  The British Royal Navy prevented scurvy by supplementing the sailors' diet with lemon and/or lime juice.  So now you know why pirates are sometimes called limeys.