378 ASCORBIC ACID 



A dose of 50 to 100 mg. will clear lesions of scurvy, although it may take 

 4 g. of the material to saturate the tissues of scorbutic subjects. The usual 

 dose in persons suspected of scurvy is 100 mg. three or five times a day by 

 mouth, continued until 4 g. have been administered, then 100 mg. twice a 

 day. In patients who are critically ill with scurvy 1000 mg. can l)e given 

 daily by intravenous drip or in divided doses of 100 mg. each intramuscu- 

 larly. In infants and young children, a dose of 10 to 25 mg. three times a 

 day will be adequate. 



Scorbutic lesions heal rapidly when vitamin C is given. Apathy, list- 

 lessness, severe weakness, and shock-like states disappear and periodic 

 breathing is normalized within 24 hours. Spontaneous bleeding ceases 

 within the same period of time. Fever disappears within 24 to 48 hours as 

 does bone and muscle pain. Within 2 to 3 days the gums lose their blue-red 

 appearance and begin to heal. Perifollicular hemorrhages turn brown in 3 to 

 4 days and, in healing, leave a pigmented hyperkeratotic papule around 

 the follicle. Even large ecchymoses and deep hematomata are resorbed 

 in 10 to 12 days. The skin may show pigmentation for months, particularly 

 in the areas of extensive hemorrhages. 



Blood regeneration begins almost immediately. In 3 to 5 days the 

 marrow is hyperactive and normoblastic. Erythrocyte and hemoglobin 

 levels will increase in 5 to 7 days and will reach normal in 2 to 4 weeks, 

 depending on the severity of the anemia. If complications such as chronic 

 infection, severe renal disease, or cachexia are present, blood regeneration 

 may be slow. 



Serum bilirubin and urine and stool urobilinogen levels are within normal 

 limits 3 to 5 days after ascorbic acid is begun. The excessive excretion of 

 "tyrosyl" substances in the urine after a test dose of tyrosine is normalized 

 within 48 hours. 



Ascorbic acid has been suggested, without confirmatory evidence, for 

 the treatment of numerous and diverse diseases unrelated to a deficiency of 

 this substance, principally because it is a strong reducing agent and is al- 

 leged to have potent detoxifying properties. For these reasons it has been 

 used in the treatment of hay fever and asthma^ and in conjunction with 

 histidine in peripheral arterial disease.^ It has been combined with mer- 

 curial diuretics because it is supposed to reduce toxicity, and it has been 

 used in other heavy metal intoxications for the same reason.^ It has been 

 recommended in the treatment of barbiturate poisoning. It has been used 

 in the treatment of congenital methemoglobinemia with reduction in the 



' S. L. Ruskin, Am. J. Digest. Diseases 12, 281 (1945). 



8M. T. Friedell, E. F. Drucker, and W. J. Pickett, J. Am. Med. Assoc. 138, 1036 



(1948). 

 9 H. N. Bundesen, H. C. S. Aron, R. S. Greenebaum, C. J. Farmer, and A. F. Abt, 



J. Am. Med. Assoc. 117, 1692 (1941). 



