Scurvy Diagnosis and Treatment

Clinical Presentation and Diagnosis

The American Academy of Pediatrics notes that while formula and human milk contain adequate vitamin C, exclusive cow milk feeding without supplementation places older infants at risk 3, 4
Perifollicular hemorrhages are a characteristic symptom of scurvy 1
Radiographic features of scurvy include osteopenia with increased sclerosis of zones of provisional calcification, dense epiphyseal rings, extensive calcification of subperiosteal and soft tissue hemorrhages, metaphyseal irregularity and thickening, and epiphyseal separation in severe cases 3, 4

For pediatric patients with scurvy, initiate oral vitamin C at 15-25 mg/kg/day for infants up to 12 months or 80 mg/day for older children, with treatment continuing for at least one month until clinical symptoms resolve 1, 2
The American Academy of Pediatrics recommends that do not delay treatment while awaiting laboratory confirmation if clinical features are present, diagnosis should be made clinically based on characteristic symptoms 1
Plasma vitamin C measurement is the preferred test when laboratory confirmation is needed, and testing should only be ordered for suspected scurvy or chronic low intake 1
Plasma levels are unreliable when CRP >10 mg/L, and normal values are not detected if CRP >40 mg/L 1, 5

Healthy children require 75-90 mg/day of vitamin C, achievable through diet 1
Children with chronic restrictive diets require 200-500 mg/day indefinitely 1, 5
Post-bariatric surgery patients require 200-500 mg/day long-term 5
Absolute contraindications to high-dose vitamin C include hemochromatosis or iron overload conditions, G6PD deficiency, history of oxalate kidney stones, and severe renal dysfunction without dialysis support 2, 5
Pediatric patients under 2 years are at higher risk of oxalate nephropathy due to age-related decreased glomerular filtration, and children with kidney disease (CKD stages 1-4) should not exceed 100 mg/day to prevent oxalate accumulation 2