The symptoms of scurvy usually begin three months after a person stops getting enough vitamin C in the diet. The initial symptoms of scurvy include generalized fatigue, malaise, irritability, fever, pain and swelling over long bones, and the appearance of small blue-red spots on the skin.
If left untreated, scurvy can progress to severe problems such as swollen gums, which become soft and vulnerable to bleeding. The teeth may feel loose or fall out. There may be soreness and stiffness of the joints and lower extremities . The petechial hemorrhages and spots develop over the skin at the site of hair follicles, and they often occur on the shins. The hair in the affected area usually twist around like corkscrews and break away easily.
In infants and children, there can be premature stopping of bone growth and complications like pseudoparalysis. Other symptoms include bulging eyes, dry, scaly and brownish skin, poor healing of wounds, pin-point red marks over the bleeding areas, hyperkeratosis and sicca syndrome. In the late stages, jaundice, generalized edema, oliguria, neuropathy, fever, shortness of breath, anemia, convulsions and eventual death are seen.
Scurvy can be diagnosed by taking complete medical history with detailed questioning about the patient’s dietary habits. Physical examination should be done to look for swollen and bleeding gums and rest of the symptoms .
Various blood tests can be used to analyze serum ascorbic acid and iron levels . Sometimes radiological procedures such as X-rays of the joints (including the knee, wrist and ribs) are ordered for diagnostic purposes.
Administration of vitamin C is the specific therapy for scurvy. A dose of 250mg vitamin C 3 times daily by mouth should saturate the tissues quickly. The deficiencies of the patient’s diet should also be corrected and other vitamin supplements given if necessary .
Orange juice usually functions as an effective dietary remedy. Other nutritional deficiencies, such as anemia, may also need to be corrected with improved balanced diet and short term use of supplements. Dietary intake of vitamin C more than 1 g/day have been reported to cause diarrhea, abdominal pain, cramps, and the formation of renal oxalate stones.
Scurvy is caused by a lack of vitamin C in the diet for a prolonged time. People who eat less than two fruits or vegetables per day are more prone to develop the disease. A number of factors such as bottle feeding in infants with cow’s milk, pregnancy, lactation, smoking, alcohol consumption and pathological conditions (such as Crohn’s disease and malabsorption syndrome) increase the risk of scurvy in these people.
Infants and children with severe malnutrition or restrictive diets are also at risk for scurvy  . There are various factors or lifestyle issues that might increase the risk of scurvy. These include crash dieting, allergy diets, fussy eating and eating disorders like anorexia nervosa or bulimia. Certain cancers may also cause vitamin C deficiency . Hemodialysis in the patients with type 1 diabetes mellitus may also cause scurvy  .
Scurvy is rare in the United States. The disease is more common in older individuals who are not getting proper nutrition. The condition is particularly common in the under developed regions and third world countries that particularly suffer from the deficiency of vitamin C. The disease is more prevalent in populations that have a low amount of fruits and vegetables in diet.
Ascorbic acid is the most active reducing agent in the aqueous phase of living tissues and is involved in intracellular electron transfer. It takes part in the hydroxylation of proline and lysine in protocollagen to hydroxyproline and hydroxylysine in mature collagen. Hydroxyproline and hydroxylysine are important for stabilizing collagen by cross-linking the propeptides in collagen.
Defective collagen synthesis impairs wound healing. Collagen is an important part of bone, so bone formation is also affected. In the blood vessels, the defective connective tissue leads to fragile capillaries, and causes capillary hemorrhage and reduced platelet adhesiveness. Vitamin C is also important for many other metabolic processes including antioxidant function, iron absorption, and for its role as neurotransmitter in brain.
High-dose vitamin C improves immune function including resistance to common cold. It is very easily destroyed by heat, increased pH and light, and is very easily soluble in water; hence many traditional cooking methods reduce or eliminate it.
Scurvy can be prevented by consuming enough vitamin C, either in the diet or as a supplement. Dietary sources of vitamin C include fruits such as oranges, lemon, limes, tomatoes, mangoes, kiwifruits, grapefruits and strawberries. The vegetables rich in vitamin C include particularly green leafy vegetables such as cabbage, capsicum and spinach.
Vitamin C is essential for the synthesis of collagen, a major component of connective tissues. It also helps in the proper functioning of immune system, cholesterol metabolism and other biological activities. The human body lacks the ability to synthesize vitamin C, so it has to be taken from exogenous vitamin C sources such as citrus fruits and leafy vegetables in order to meet the body needs.
Scurvy is more common in older adults and alcoholics suffering from malnutrition. Scurvy was commonly associated with sailors of the 16th to 18th centuries who navigated long voyages without enough vitamin C supplements . Modern cases of scurvy are extremely rare.
Good sources of dietary vitamin C include citrus fruits and green vegetables. It is more common in infants and older individuals who do not take proper nutrition. Overdosing of vitamin C can cause problems, so more than recommended dose of vitamin C supplement should not be taken.