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Scurvy in adults - the early symptoms may be non-specific, with weakness and muscle pain.
In infantile scurvy there is irritability, painful legs, anaemia and characteristic subperiosteal haemorrhages, particularly into the ends of long bones.
Scurvy is a Deficiency of Vitamin C
Diagnosis of Scurvy
The anaemia is usually hypochromic but occasionally a normochromic or megaloblastic anaemia is seen.
The type of anaemia depends on whether iron deficiency (owing to decreased absorption or loss due to haemorrhage) or folate deficiency (folate being largely found in green vegetables) is present.
Plasma ascorbic acid is very low in obvious deficiency and a vitamin C level of less than 11 µmol/L (0.2 mg per 100 mL) indicates vitamin C deficiency.
The leucocyte-platelet layer (buffy coat) of centrifuged blood corresponds to vitamin C concentrations in other tissues. The normal level of leucocyte ascorbate is 1.1-2.8 pmol per 10 6 cells.
Treatment of Scurvy
Initially the patient is given 250 mg of ascorbic acid daily and encouraged to eat fresh fruit and vegetables. Subsequently, 40 mg daily will maintain a normal exchangeable body pool of about 900 mg (5.1 mmol).
Prevention of Scurvy
Orange juice should be given to bottle-fed infants. The intake of breast-fed infants depends on the mother's diet. In the elderly, eating adequate fruit and vegetables is the best way to avoid scurvy.
Careful surveillance of the elderly, particularly those who live alone, is necessary. Ascorbic acid supplements should only be necessary occasionally.
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