How Much Vitamin C Is Needed To Prevent Scurvy

How Much Vitamin C Is Needed To Prevent Scurvy

Approach Considerations

Because sudden death may occur in patients with scurvy, ensuring adequate vitamin C replenishment in patients with vitamin C deficiency is the hallmark of therapy. Restoration of body stores of vitamin C is essential to achieve complete resolution of symptoms. In most adult patients, provision of 250 mg of vitamin C 4 times a day for 1 week aids in achieving this goal.

Identifying and treating comorbid nutritional deficiencies (eg, iron deficiency anemia, folate deficiency, other vitamin deficiencies) are integral parts of management. Provision of a balanced and liberal diet to meet the nutritional needs of the patient aids in recovery.

Ascorbic Acid

Orange juice is an effective dietary remedy for curing infantile scurvy and was the standard treatment before the discovery of vitamin C. Upon instituting dietary or pharmacologic treatment, the clinical recovery is impressive. The appetite of the infant is recovered within 24-48 hours. The symptoms of irritability, fever, tenderness upon palpation, and hemorrhage generally resolve within 7 days.

Patients should take oral ascorbic acid at 100 mg 3-5 times a day until a total of 4 g is reached, and then they should decrease intake to 100 mg daily. Alternatively, ascorbic acid may be taken at 1 g/day for the first 3-5 days, followed by 300-500 mg/day for 1 week. Then, the recommended daily allowance is resumed.

Divided doses are given, because intestinal absorption is limited to 100 mg at one time. Parenteral doses are necessary in those with gastrointestinal malabsorption.

In October 2017, the Food and Drug Administration (FDA) approved Ascor (ascorbic acid) for the short-term (<1 wk) treatment of scurvy in adults and children aged 5 months or older for whom oral administration is not possible, is insufficient, or is contraindicated. The exact mechanism of action of ascorbic acid for the treatment of scurvy is unknown. It is believed that the administration restores the body pool of ascorbic acid.

The recommended adult dose is 200 mg IV daily, and treatment should not exceed 7 days. If there is no improvement in scorbutic symptoms, re-treat until resolution of scorbutic symptoms is observed. ^[39]

Diet

A diet adequate in vitamin C can prevent the development of scurvy. Foods high in vitamin C include citrus fruits, especially grapefruits and lemons; berries and cantaloupe; and vegetables, including broccoli, spinach, green peppers, tomatoes, potatoes, cauliflower, and cabbage.

The recommended daily allowance for vitamin C varies with the age of the individual. The current recommendation for adults is 120 mg daily, although a dose of 60 mg daily is all that is required to prevent scurvy. Some experts think the level should be as high as 200 mg daily to match the level present in 5 servings of fruits and vegetables daily, a diet shown to decrease cancer risk.

The Food and Nutrition Board of the National Academy of Sciences and the National Research Council have provided minimum recommended daily dietary allowances of vitamin C (see the table below) ^[6] :

Table. (Open Table in a new window)

Age	Recommended Amount
Birth to 6 mo	40 mg
Infants 7-12 mo	50 mg
Children 1-3 yr	15 mg
Children 4-8 yr	25 mg
Children 9-13 yr	45 mg
Boys 14-18 yr	75 mg
Girls 14-18 yr	65 mg
Men	90 mg
Women	75 mg
Pregnant females <18 yr	80 mg
Pregnant women 19-50 yr	85 mg
Breastfeeding females <18 yr	115 mg
Breastfeeding women 19-50 yr	120 mg

Megadoses of vitamin C have not been shown in clinical trials to reduce viral illnesses such as colds. Large doses of vitamin C (ie, more than 1 g/day) may increase the risk of certain illnesses such as kidney stones, particularly oxalate stones.

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Author

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Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

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Arthur B Chausmer, MD, PhD, FACP, FACE, FACN, CNS is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Nutrition, American Society for Bone and Mineral Research, International Society for Clinical Densitometry, American College of Endocrinology, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Informatics Association, Endocrine Society

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George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

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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

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Anne Elizabeth Laumann, MBChB, MRCP(UK), FAAD Professor Emerita of Dermatology, 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, American Academy of Dermatology Association, American College of Wound Healing and Tissue Repair, American Dermato-Epidemiology Network, Association for Psychoneurocutaneous Medicine of North America, Association of Professors of Dermatology, British Association of Dermatologists, Chicago Dermatological Society, Chicago Medical Society, Dermatology Foundation, European Society of Tattoo and Pigment Research, Illinois Dermatological Society, Illinois State Medical Society, Institute of Medicine of Chicago, Lupus Foundation of America, Illinois Chapter, Medical Dermatology Society, National Psoriasis Foundation, National Vitiligo Foundation, North American Rheumatologic Dermatology Society, Rheumatologic Dermatology Society, Scleroderma Foundation, Society for Investigative Dermatology, The Global Fibrosis Foundation, Women's Dermatologic Society

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Henry Driscoll, MD Farrell Professor Emeritus of Endocrinology, Chief Emeritus, 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, The Scientific Research Honor Society, West Virginia State Medical Association

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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

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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.

How Much Vitamin C Is Needed To Prevent Scurvy

Source: https://emedicine.medscape.com/article/125350-treatment