Vitamin C status follows the following stages (Hodges, 1980):
• The optimal stage with full saturation of the metabolic body pool.
• If the diet is less than optimal for some time, the metabolic body pool decreases in size, the person remains clinically well, and plasma levels remain within the normal range.
• If a deficient diet is consumed for a long enough period, the body pool is substantially depleted and plasma levels decline to the lower ranges of normal but with no clinical signs.
• The continuation of a deficient diet results in further decreases in the body pool size of vitamin C to 300 mg or less, a reduction in the catabolic rate to 9 mg or less, and the whole blood vitamin C content to a level below 0.3 mg/100 ml. Clinical signs of scurvy appear.
Manifest scurvy in adults is preceded by a period of latent scurvy whose early symptoms include lassitude, weakness and irritability; vague, dull aching pains in the muscles or joints of the legs and feet; and weight loss. Shortness of breath may also occur and the skin can become dry and rough. The principal signs and symptoms of manifest scurvy in adults consist of follicular hyperkeratosis, haemorrhagic manifestations, swollen joints, swollen bleeding gums, and peripheral oedema (Hodges et al., 1971). Anaemia of a variable degree occurs with scurvy in a certain percentage of adults and infants, which is considered to be due in part to undernutrition and intercurrent infection. However, it is due chiefly to the effect of vitamin C on blood formation, folic acid metabolism, and bleeding. In children the syndrome is called Moeller-Barlow disease, and is seen in non-breast-fed infants usually at about 5-6 months of age when maternally derived stores of vitamin C have been exhausted. No single symptom predominates, but the majority of infants with scurvy eventually show signs of irritability, tenderness of the legs, and pseudo paralysis, usually involving the lower extremities. The "pithed-frog" position-legs flexed at the knees and hips partially flexed-is assumed by approximately half the sufferers. Involvement of the costochondral junctions is very common, and costochondral beading is found in 80% of infants with scurvy. Haemorrhage around erupting teeth is consistently present. Petechial haemorrhages in the skin may occur (10 -15% of infants with scurvy). Left untreated, scurvy in any age group can lead to death.