Scurvy

What Is Scurvy?

Dating back to ancient Egypt, scurvy represents an abnormal condition of ascorbic acid or Vitamin C deficiency in the diet. The earliest records of the symptoms associated with scurvy are the contribution of Egyptian scribes, dating back to 1550 BC. Scurvy ravaged its victims of ocean exploration during the Renaissance Era of the 16th through the 18th centuries indiscriminately.

In the course of the year 1746, a British naval surgeon named James Lind proved that citrus fruits including oranges and lemons had strong properties to treat and prevent scurvy. As a result of Dr. Lind’s efforts, the relative frequency of developing scurvy otherwise called Vitamin C deficiency, ascorbic acid deficiency syndrome, Vitamin C deficiency disease, and Barlow’s disease, among the British naval men diminished. Lemon juice provisions became the standard on board routine sea expeditions.

Throughout the 19th century, people suffered a myriad of tribulations and significant events. They experienced the Great Potato Famine, the American Civil War, the Crimean War in Europe, and the California Gold Rush. By no longer being a maritime voyager’s disease, scurvy evolved into a disease affecting countless people on terra firma.

Scurvy & Rickets

Accredited for the earliest description of infantile scurvy, Francis Glisson discovered a link between rickets and scurvy relating to infants in 1650. Subsequent to his narrative regarding this relationship, it took 200 years more before any further reports of these findings made it to mainstream authorities.

Infantile Scurvy

By the end of the 19th century, infantile scurvy received acknowledgment in Great Britain and the United states due to the increased incidence of the disease. The conclusion was that the ingestion of pasteurized milk and foods that contain insufficient quantities of Vitamin C caused the manifestation of scurvy.

Scurvy? Get Remedies Fast!

Axel Holst, a Norwegian university professor and a pediatrician named Dr. Theodor Frølich evoked the induction and treated scurvy in guinea pigs with the use of through adjustment relating to their diet. The employment of an animal model used to promote and cure scurvy equated to an outstanding advancement. The progress made with the use of guinea pigs led the way to integration of using human subjects for experimentation.

At a point in 1914, a pediatrician names Alfred Hess who practiced at Hebrew Asylum in New York, noted a growing number of cases of scurvy amidst the babies at the institution. The institution of the milk pasteurization along with omitting orange juice from the nutritional components of the infants’ diet was the underlying basis for the rise of infantile scurvy.

Early Treatment Findings

Dr. Hess was able to undo the absence of vitamin C in the infants by adding orange juice, non pasteurized milk or potatoes to their diet. This improvement in their uptake reversed the effects of scurvy. Dr. Hess demonstrated that the loss of vitamin C was the result of the pasteurization. Hence, his recommendation for the prevention and treatment of infantile scurvy was to supply citrus fruit or vegetable juice to the diet of the infants that received heated formula exclusively. Leading to the elimination of infantile scurvy in the United States, this added measure prevented the infants from the impact of scurvy.

The daily consumption of fresh fruits and vegetables or the protective approach of supplementing the diet with added Vitamin C represents a significant way to prevent ascorbic acid insufficiency. Unfortunately, the human body misses the element needed to produce ascorbic acid. The body needs fruits and vegetable to satisfy Vitamin C requirements needed for wellness. Unfortunately, scurvy makes up a remarkable vitamin deficiency syndrome that regards adults and children who have prolonged Vitamin C shortcoming in their diet.

Pathophysiology

Whether caused by disease or the following result from a syndrome, the study of the shifts in the involuntary physical and biochemical dynamic processes have a pivotal role. They provide the understanding of basic causes of disorders in the body. Pathophysiology is the subdivision of medicine, which addresses the disruptions of body functions due to illness or the foreshadowing symptoms.

The principle function of Vitamin C comprises the biosynthesis of collagen needed for the fortification of skin, bone, and connective tissues throughout the body. A Vitamin C deficient effects the body organs’ collagen-containing tissue namely the skin, cartilage, bones, capillaries, and the calcium-containing part of the teeth called dentine. There are numerous reasons why the observation of infant growth rate is vital.

Pathological Variants

Pathological variants affect the production of tissue and functionality of the body. Irrespective externally or internally, the loss of blood from a ruptured blood vessel personifies a distinguishable feature of scurvy, and it causes serious complications when the hemorrhage takes place in an organ. Another indicant of scurvy is abnormal collagen formation. It contributes to poor dentine synthesis, bleeding gums, and the loss of teeth inevitably. A frequent site of dermal bleeding is the hair follicle. In relation to infantile scurvy, bone inclusion is a distinctive characteristic.

The occurrence of body changes happens at the juncture of the central section of the long bone in between the growth expanses at each end. Bone-forming cells also called osteoblasts are unsuccessful in the attempt to form the bone tissue that becomes hard bone, as a result, the endochondral bone development stops. Calcification of growth cartilage situated at the juncture of the long bones persists, contributing to the growth plate becoming more compact.

As a rule, the dispersal of growth cartilage byway of the capillary vessels does not take place. Because of the process of undergoing resorption, the bone becomes weak, and tiny cracks of the bone spicules develop between the diaphysis and hardened cartilage. Because of the fractures, the dense fibrous membrane covering the surface of bones called the periosteum become lax, consequent to a subperiosteal bleed at the endings of the long bones. Standardized guidelines practiced in the assessment of fractures pertaining to infants and adolescent children are in place. The attached segment of the periosteal to the growth plate is sturdy.

Scurvy in the United States

In the United States, the incidence of scurvy is unique because of the incorporation of Vitamin C incorporated in foods more and more. This western standard makes the risk of developing scurvy seem to be a matter of the past. Scurvy represents a nondiscriminatory condition that does not recognize gender or race. Today, individuals that are the most vulnerable to developing scurvy in the USA are, however, the elderly, psychiatric patients, drug abusers, alcoholics, finicky eaters, the homeless, and persons suffering from acid ingestion. Additionally, dialysis-dependent individuals and babies who do not receive sufficient Vitamin C in their diet may fall victim to scurvy.

Among the various physical damage accompanying, the ill-use of alcohol in the midst of some elderly-adult drinkers is water-soluble vitamin deficiency. The primary reason is the consumption foods lacking Vitamin C supplied in fresh fruits and vegetables. Children who are subject to limited food due to health-related issues, cultural, or monetary justifications have a high probability of developing Vitamin C insufficiency leading to scurvy. It is remarkable for infants up to a year old to acquire scurvy because of nutritional information and resources available to parents.

International Occurrences of Scurvy

With regard to a few provinces scattered throughout Asia, there have been an increase in the outbreak of scurvy. In 2002, scores of people in an unlikely part of Afghanistan died subsequent to what seemed to be a direct occurrence of a disease associated with poor nutrition. Between 2004 and 2008, over 60 children in England received hospitalization due to scurvy. Late 2007, the estimation rose to 94 cases of scurvy, which indicates a substantial upsurge of more than 50% within a 3-year span.

A case study in Thailand reassessed 28 instances of scurvy in infants and children with an age range from 10 months to 9-and-half-years. The average child was 29 months old, and the children remained hospitalized for a little over 7 years from 1995 to 2002. The determinant was that constant uptake of ultra-pasteurized milk and insufficient consumption of fresh vegetables and fruits were the key factor that induced scurvy. Unless there is a real turn around regarding this issue, scurvy could once again be the scourge of populations in epidemic proportions in these middle-eastern regions.

Occurrence of Scurvy and Mortality

Scurvy has unfavorable impacts on the neonatal brain’s correct maturation. Based on the potential damage from Vitamin C deficiency, the latest research-laboratory studies indicate that the newborn child’s brain is vulnerable to impairment from scurvy. In relation to infants and adults, there is evidence that supports the connections between scurvy and unexpected death resulting from heart failure, as well.

The occurrence secondary to prolonged exposure to scurvy causes deep tissue hemorrhaging, which is a frequent complication that raises the fatality rate in young children and mature adults. Subperiosteal bleeding causes extreme pain and physical flaws in bone and other connected anatomical structures. Dependent on the location of the bleed, for example, in the brain, the hemorrhage raises the fatality rate substantially.

Clinical Symptomatology

Non specific indications of scurvy consist of the following:

• Poor appetite
• Mood swings
• Unexplained weight loss
• Fever
• Frequent and/or excessive bowel movements
• Labored breathing

Identifiable symptoms include the following:

• Muscular paralysis with pain and soreness of the lower extremities
• Swelling across the long bones
• Bleeding from broken blood vessels into encompassing tissue

Physical Indicators

Resulting from pseudoparesis, the infant appears irritable during handling and diaper changes. The child exhibits severe, palpable sensitivity over the thighs with excruciating pain. For solace, the infant simulates the frog-leg position, maintaining hips and knee joints slightly bent and externally spread out.

Gum-line hemorrhage takes place only if teeth eruption is apparent. Typically, bleeding gums involve the tissue around the teeth located in front of the mouth, in the superior and inferior jaws. The gums feel sponge-like and reveal a blue to purplish hue.

Hemorrhaging

Subperiosteal hemorrhage represents a typical determinant concerning infantile scurvy. The lower points of the thighbone and shinbone are the most impacted placements, and the area is painful to the touch in the acute phase.

Petechial hemorrhage of the skin and mucous membranes can occur. When the capillaries close to the superficial part of the body rupture, this state arises. Blood in the urine or stool is not distinguished. Eye proptosis is an indicator of an orbital bleed, which is a predication of scurvy. This condition results in an ensnarement and shift of the eye from the back of the lids of the eyeballs.

Problems With Ribs

A beading or protuberance of the ribs at the costochondral junction is a widely seen in individuals with scurvy. The occurrence is at the joining of the ribs and sternum located where the developing portion of the ribs to cartilage attaches. The scorbutic rosary is distinguishable because of its angular-like development. The profusion of growth of the cartilage induces the ribs and cartilage to compress and the overgrowth produces an abnormal formation of the rib cage.

Vitamin A Deficiency

Typically, adult scurvy induces Vitamin A deficiency, which is responsible for a skin thickening disorder called hyperkeratosis. It also produces an autoimmune disease called sicca syndrome or Sjögren’s syndrome are typical observations in adult scurvy; however, it is unusual in infantile scurvy. Connective tissue diseases, comprising lupus, scleroderma, rheumatoid arthritis, and polymyositis are autoimmune disorders. They contribute to dry eyes and mouth.

Additional Warning Signs

Slow-to-heal wounds, insufficient production of red blood cells, and mild fever represent signals that warrant testing for scurvy.

Although a rarity, there has been a case involving an infant that experienced non-scarring alopecia, spread throughout the scalp and features through radiographic imaging that indicate scurvy.

Laboratory Analyses

Infantile scurvy is not diagnosed with lab test easily. In order to ascertain the presence of scurvy in an infant, verification of radiological images and clinical research substantiating a Vitamin C deficiency is appropriate to establish a diagnose of infantile scurvy.

Blood Serum Ascorbic Acid Levels

• Serum ascorbic acid levels more exceptional than 0.6 mg/dL eliminates the appearance of scurvy.
• Ascorbic acid levels of more than 0.2 mg/dL are nutritionally sufficient.
• A blood serum level of 0.10-0.19 mg/dL establishes a low level notably.
• Serum levels that present lower than 0.10 mg/dL is a remarkable deficient.

Alternative Blood Testing

A more accurate measurement of ascorbic acid concentration is the white blood cell serum level. It provides a precise way to determine Vitamin C insufficiency.

• A WBC serum level of zero suggests possible scurvy.
• Levels of 0-7 mg/dL assume a substantial point of deficit.
• Blood serum levels of 8-15 mg/dL are remarkable to a degree
• Levels greater than 15 mg/dL are an excellent indicant of nutritional sufficiency.

Dietary Guidelines

A diet sufficient in Vitamin C inhibits the progress of scurvy. The dietary essentials of Vitamin C capable of the prevention of scurvy change at different stages of the aging process of the individual. The following dietary recommendations for the daily allowance consist of the following:

• Infants – 30-40 mg
• Children and young adults 40-45 mg
• Mature adults 60 mg
• Pregnant women – 70 mg
• Lactating mothers – 95 mg

Food sources abundant in Vitamin C include the following:

• Citrus fruits, such as grapefruit, oranges, tangerines, lemons, and limes
• Black currant
• Green tomatoes
• Kiwi
• Acerola cherry
• Litchi
• Berries
• Guava
• Cantaloupe
• Sweet red pepper
• Broccoli
• Brussels sprouts
• Peas
• Lettuce
• Cassava
• Cauliflower
• Potatoes
• Cabbage
• Melon
• Spinach
• Potatoes
• Tomatoes

Medication

Vitamin C Supplementation

The chemical composition of ascorbic acid derives from plants. Most animals produce ascorbic acid from glucose. Humans cannot synthesize this nutrient, and it cannot be stored in the body, so Vitamin C must be ingested daily. The best sources of Vitamin C are fresh vegetables and fruits. Ascorbic acid is essential to meet the needs of proper body function. Vitamin C provides antioxidants, which neutralize free radicals that induce cell damage.

Antitoxins neutralize a wide array of toxic substances that accumulate in the body. It strengthens the immune system ability to fight infection. Vitamin C enhances collagen formation, which is necessary for wound healing. It fortifies capillary and arterial walls to prevent rupture and ecchymosis. Ascorbic acid facilitates the integration of non-heme iron that comes from eggs, dairy products, and plant-based foods. Clinically, Vitamin C supplements are necessary to guard against and treat a state of deficiency.

Ascorbic acid Supplementation

Ascorbic acid, Vitamin C, Cecon, Cebid, Ce-Vi-Sol, Dull-C, and Vita-C are oral supplements that administer effective reversal of infantile and adult scurvy.

Adult Dosing

100-200 mg orally every 6 hours for 1 week

Pediatric

25 mg orally every 6 hours for 1 week

Interactions

The consumption of Vitamin C supplementation in large doses impedes the metabolic process and absorptivity of Vitamin B-12 in the body.

Contraindications

Large doses hasten hemolysis in individuals with glucose-6-phosphate dehydrogenase insufficiency. Mass dosages exacerbated acid loading in conditions, such as gout, cirrhosis, renal tubular acidosis, and paroxysmal nocturnal hemoglobinuria.

Pregnancy Precautions

In humans, fetal risk factors are not supported in research studies; however, some hazardous indications display in animal studies.

Cautionary Information

Vitamin C abuse stimulates diarrhea and renal stones. Prolonged uptake of ascorbic acid impedes synthesis, and it causes metabolic resistance biochemically.

There have been reports of scurvy in regards to infants born to mothers who ingested as high as 400 mg/dL of Vitamin C during their gestation period. The manifestation of low-serum ascorbic acid levels exhibited in healthy adults who took large doses of Vitamin C for extended periods.

Prognosis

Scurvy features a highly agreeable prognosis, as long as it is diagnostically identified and treated promptly.