Cyanosis

Aka: Cyanosis, Peripheral Cyanosis, Central Cyanosis

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II. Pathophysiology

  1. Blood components responsible for Cyanosis
    1. Deoxygenated Hemoglobin > 5 g/dl or
    2. Methemoglobin >1.5 g/dl or
    3. Sulfhemoglobin >0.5 g/dl

III. Precautions

  1. Cyanosis appears when at least 5 g/dl of Hemoglobin is deoxygenated (desaturated)
    1. Anemic patients (e.g. Hemoblobin <10 g/dl)
      1. May not appear cyanotic despite Hypoxia
    2. Polycythemic patients (e.g. Hemoblobin >17-20 g/dl) such as those with COPD or Pulmonary Hypertension
      1. May appear cyanotic in mild Hypoxia

IV. Signs

  1. Blue coloration to skin and mucous membranes

V. Causes: Central Cyanosis (Cyanosis of the trunk and head)

  1. Airway obstruction (e.g. Airway Foreign Body)
  2. Asthma
  3. Interstitial Lung Disease
  4. COPD
  5. Atelectasis
  6. Pulmonary Embolism
  7. Hypoventilation (e.g. Altered Level of Consciousness)
  8. Pulmonary Edema
  9. Pneumonia
  10. Pulmonic stenosis
  11. Congestive Heart Failure
  12. Non-Hemoglobin related causes
  13. Methemoglobinemia
  14. Polycythemia Vera
  15. Myocardial Infarction

VI. Causes: Peripheral Cyanosis (local Cyanosis or extremity Cyanosis)

  1. Early in course of Central Cyanosis causes (that will progress to Central Cyanosis without intervention)
  2. Hypovolemia
  3. Cold extremities
  4. Raynaud Syndrome
  5. Peripheral Arterial Disease
  6. Deep Vein Thrombosis
  7. Venous Stasis

VII. Differential Diagnosis

  1. See Skin Discoloration

VIII. References

  1. Degowin (1987) Diagnostic Examination, p. 335-6

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