Cyanosis risk factors: Difference between revisions

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{{CMG}}; {{AE}} {{CK}}
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==Overview==
==Overview==
*Common risk factors in the development of [[cyanosis]] include [[Congenital heart disease|congenital heart diseases]] with right to left shunting, presence of [[Hemoglobinopathy|abnormal hemoglobin]], [[carbon monoxide poisoning]], respiratory disorders associated with impaired [[gas exchange]], impaired gas diffusion via the [[Pulmonary alveolus|alveoli]], [[Pulmonary embolism|embolism]], [[Arteriovenous malformation|arteriovenous malformations]], [[Hypothermia|cold exposure]], and [[raynaud's phenomenon]].
[[Cyanosis]] is the sign of underlying disease. Risk factors related to the presence of underlying conditions should be noticed.
Common risk factors in the development of [[Congenital heart disease|congenital heart diseases]] with the right to left shunt include maternal age >35 years, No intake of the multivitamin, febrile illness in the first trimester, [[obesity]], paternal age> 25 years.
 
==Risk Factors==
==Risk Factors==
The risk factors for [[cyanosis]] include:<ref name="pmid29489181">{{cite journal |vauthors=Adeyinka A, Kondamudi NP |title= |journal= |volume= |issue= |pages= |date= |pmid=29489181 |doi= |url=}}</ref><ref name="pmid29439874">{{cite journal |vauthors=Martínez de Zabarte Fernández JM, García Íñiguez JP, Domínguez Cajal M |title=Metahemoglobinemia in infants over one year |journal=Med Clin (Barc) |volume= |issue= |pages= |date=February 2018 |pmid=29439874 |doi=10.1016/j.medcli.2017.12.009 |url=}}</ref><ref name="pmid19144126">{{cite journal |vauthors=Bailliard F, Anderson RH |title=Tetralogy of Fallot |journal=Orphanet J Rare Dis |volume=4 |issue= |pages=2 |date=January 2009 |pmid=19144126 |pmc=2651859 |doi=10.1186/1750-1172-4-2 |url=}}</ref><ref name="pmid6021453">{{cite journal |vauthors=Just-Viera JO, Norwood T, Yeager GH |title=Importance of shock and cyanosis in pulmonary embolism |journal=Ann. Surg. |volume=165 |issue=4 |pages=528–35 |date=April 1967 |pmid=6021453 |pmc=1617449 |doi= |url=}}</ref><ref name="pmid14091905">{{cite journal |vauthors=FRASER RS, SPROULE BJ, DVORKIN J |title=HYPOVENTILATION, CYANOSIS AND POLYCYTHEMIA IN A THIN MAN |journal=Can Med Assoc J |volume=89 |issue= |pages=1178–82 |date=December 1963 |pmid=14091905 |pmc=1922100 |doi= |url=}}</ref>
The risk factors for [[cyanosis]] include:
*Any condition that interferes with oxygen from entering the [[Pulmonary alveolus|alveoli]] or interrupts its movement across the alveolar interface leads to [[hypoxemia]] and [[cyanosis]].
*Any condition that interferes with oxygen from entering the [[Pulmonary alveolus|alveoli]] or interrupts its movement across the alveolar interface leads to [[hypoxemia]] and [[cyanosis]].
**'''Decreased inspired oxygen'''
**'''Decreased inspired oxygen'''<ref name="pmid11387414">{{cite journal |vauthors=Blumenthal I |title=Carbon monoxide poisoning |journal=J R Soc Med |volume=94 |issue=6 |pages=270–2 |date=June 2001 |pmid=11387414 |pmc=1281520 |doi= |url=}}</ref><ref name="pmid21051109">{{cite journal |vauthors=Dueñas-Laita A, Burillo Putze G, Alonso JR, Bajo A, Climent B, Corral E, Felices F, Ferrer A, Hernández Frutos MP, Nogué S, Puiguriguer J |title=[Basis for the clinical management of fire smoke poisoning "Docohumo Madrid 2010"] |language=Spanish; Castilian |journal=Med Intensiva |volume=34 |issue=9 |pages=609–19 |date=December 2010 |pmid=21051109 |doi=10.1016/j.medin.2010.07.007 |url=}}</ref>
***[[Carbon monoxide poisoning|Carbon monoxide]] exposure
***[[Carbon monoxide poisoning|Carbon monoxide]] exposure
***[[Cyanide poisoning]]
***[[Cyanide poisoning]]
***Smoke from house fires
***Smoke from house fires
**'''Hypoventilatory disorders:'''
**'''Hypoventilatory disorders:'''<ref name="pmid14620600">{{cite journal |vauthors=Zoorob RJ, Campbell JS |title=Acute dyspnea in the office |journal=Am Fam Physician |volume=68 |issue=9 |pages=1803–10 |date=November 2003 |pmid=14620600 |doi= |url=}}</ref>
***'''[[Airway obstruction|Upper airway obstruction]]'''
***'''[[Airway obstruction|Upper airway obstruction]]'''
****[[Pulmonary aspiration|Foreign body]]
****[[Pulmonary aspiration|Foreign body]]
Line 20: Line 22:
****Traumatic airway disruption
****Traumatic airway disruption
****Congenital airway anomalies
****Congenital airway anomalies
***'''Neurologic disorders:'''
***'''Neurologic disorders'''<ref name="pmid11129917">{{cite journal |vauthors=Ranjit MS |title=Cardiac abnormalities in birth asphyxia |journal=Indian J Pediatr |volume=67 |issue=3 Suppl |pages=S26–9 |date=March 2000 |pmid=11129917 |doi= |url=}}</ref><ref name="pmid28722923">{{cite journal |vauthors=Kondamudi NP, Dulebohn SC |title= |journal= |volume= |issue= |pages= |date= |pmid=28722923 |doi= |url=}}</ref><ref name="pmid28722926">{{cite journal |vauthors=Kondamudi NP, Virji M |title= |journal= |volume= |issue= |pages= |date= |pmid=28722926 |doi= |url=}}</ref>
****Severe [[Head injury|head trauma]]
****Severe [[Head injury|head trauma]]
****Transient tachypnea of newborn
****Transient tachypnea of newborn
Line 27: Line 29:
****Hypoxic ischemic encephalopathy
****Hypoxic ischemic encephalopathy
****[[Intracranial hemorrhage]]
****[[Intracranial hemorrhage]]
**'''Impairment of chest wall or lung expansion'''
**'''Impairment of chest wall or lung expansion'''<ref name="pmid24734096">{{cite journal |vauthors=Choi WI |title=Pneumothorax |journal=Tuberc Respir Dis (Seoul) |volume=76 |issue=3 |pages=99–104 |date=March 2014 |pmid=24734096 |pmc=3982243 |doi=10.4046/trd.2014.76.3.99 |url=}}</ref>
***[[Pneumothorax]]
***[[Pneumothorax]]
***[[Hemothorax]]
***[[Hemothorax]]
***[[Flail chest]]
***[[Flail chest]]
**'''Impaired alveolar-arterial diffusion''': [[Pulmonary edema]]
**'''V/Q mismatch''':
**'''Intrinsic lung diseases'''
***'''Obstructed airways (V):'''<ref name="pmid14091905">{{cite journal |vauthors=FRASER RS, SPROULE BJ, DVORKIN J |title=HYPOVENTILATION, CYANOSIS AND POLYCYTHEMIA IN A THIN MAN |journal=Can Med Assoc J |volume=89 |issue= |pages=1178–82 |date=December 1963 |pmid=14091905 |pmc=1922100 |doi= |url=}}</ref><ref name="pmid22393337">{{cite journal |vauthors=Garvey C, Ortiz G |title=Exacerbations of chronic obstructive pulmonary disease |journal=Open Nurs J |volume=6 |issue= |pages=13–9 |date=2012 |pmid=22393337 |pmc=3282915 |doi=10.2174/1874434601206010013 |url=}}</ref>
***[[Asthma]]
****[[Asthma]]
***[[Chronic obstructive pulmonary disease|COPD]]
****[[Chronic bronchitis]]
***[[Pneumonia]]
****[[Chronic obstructive pulmonary disease|COPD]]
***[[Bronchiolitis]]
****[[Bronchiectasis|Bronchiactasis]]
***[[Acute respiratory distress syndrome|Respiratory distress syndrome]] (RDS)
***'''Vasculature (Q):'''<ref name="pmid18272123">{{cite journal |vauthors=Wang RF, Hung TY, Chong CF, Wang TL, Chen CC |title=Central cyanosis due to severe pulmonary hypertension combined with pericarditis as the initial manifestation of systemic lupus erythematosus |journal=Am J Emerg Med |volume=26 |issue=2 |pages=248.e1–2 |date=February 2008 |pmid=18272123 |doi=10.1016/j.ajem.2007.04.007 |url=}}</ref><ref name="pmid11596167">{{cite journal |vauthors=Grech V, Goldman A |title=Acute respiratory distress syndrome due to cyanotic spell in an infant with tetralogy of Fallot |journal=Pediatr. Pulmonol. |volume=32 |issue=5 |pages=406–7 |date=November 2001 |pmid=11596167 |doi= |url=}}</ref>
***[[Empyema]]
****[[Acute chest syndrome]] due to [[Sickle-cell disease|sickle cell disease]]
****[[Pulmonary embolism|Pulmonary embolus]]
****[[Vasculitis]]
***'''Parenchymal''':<ref name="pmid19462358">{{cite journal |vauthors=Kosacka M, Brzecka A, Jankowska R, Lewczuk J, Mroczek E, Weryńska B |title=[Combined pulmonary fibrosis and emphysema - case report and literature review] |language=Polish |journal=Pneumonol Alergol Pol |volume=77 |issue=2 |pages=205–10 |date=2009 |pmid=19462358 |doi= |url=}}</ref><ref name="pmid19868355">{{cite journal |vauthors=Stadie WC |title=THE OXYGEN OF THE ARTERIAL AND VENOUS BLOOD IN PNEUMONIA AND ITS RELATION TO CYANOSIS |journal=J. Exp. Med. |volume=30 |issue=3 |pages=215–40 |date=September 1919 |pmid=19868355 |pmc=2126679 |doi= |url=}}</ref><ref name="pmid12292168">{{cite journal |vauthors=Muhe L |title=Managing pneumonia |journal=Child Health Dialogue |volume= |issue=3-4 |pages=13 |date=1996 |pmid=12292168 |doi= |url=}}</ref>
****[[Acute respiratory distress syndrome|ARDS]]
****[[Pneumonia]]
****[[Interstitial lung disease|Pulmonary fibrosis]]
****Interstitial lung diseases
****[[Empyema]]
**'''Impaired alveolar-arterial diffusion''':<ref name="pmid8000933">{{cite journal |vauthors=Angerio AD, Kot PA |title=Pathophysiology of pulmonary edema |journal=Crit Care Nurs Q |volume=17 |issue=3 |pages=21–6 |date=November 1994 |pmid=8000933 |doi= |url=}}</ref>
***[[Pulmonary edema]]
*Intracardiac or vascular shunts may cause [[cyanosis]] by mixing oxygenated and deoxygenated blood.
*Intracardiac or vascular shunts may cause [[cyanosis]] by mixing oxygenated and deoxygenated blood.
**[[Congenital heart disease|Congenital heart diseases]]
**[[Congenital heart disease|Congenital heart diseases]]<ref name="pmid18851735">{{cite journal |vauthors=Martins P, Castela E |title=Transposition of the great arteries |journal=Orphanet J Rare Dis |volume=3 |issue= |pages=27 |date=October 2008 |pmid=18851735 |pmc=2577629 |doi=10.1186/1750-1172-3-27 |url=}}</ref><ref name="pmid13019603">{{cite journal |vauthors=POTTS WJ |title=[Congenital heart disease cyanotic children] |language=Undetermined |journal=Calif Med |volume=78 |issue=2 |pages=101–3 |date=February 1953 |pmid=13019603 |pmc=1521678 |doi= |url=}}</ref><ref name="pmid6021453">{{cite journal |vauthors=Just-Viera JO, Norwood T, Yeager GH |title=Importance of shock and cyanosis in pulmonary embolism |journal=Ann. Surg. |volume=165 |issue=4 |pages=528–35 |date=April 1967 |pmid=6021453 |pmc=1617449 |doi= |url=}}</ref>
***[[Tetralogy of Fallot|Tetralogy of fallot]]
***[[Tetralogy of Fallot|Tetralogy of fallot]]
***Tricuspid valve anomalies
***Tricuspid valve anomalies
Line 51: Line 63:
***Multiple intra pulmonary shunts
***Multiple intra pulmonary shunts
*[[Hypothermia|Cold exposure]]
*[[Hypothermia|Cold exposure]]
*Hemoglobinopathies
*Hemoglobinopathies:<ref name="pmid6722683">{{cite journal |vauthors=Whelan JF |title=Methemoglobin as a cause of cyanosis |journal=Can Med Assoc J |volume=130 |issue=10 |pages=1260 |date=May 1984 |pmid=6722683 |pmc=1483499 |doi= |url=}}</ref><ref name="pmid28348950">{{cite journal |vauthors=George A, Goetz D |title=A case of sulfhemoglobinemia in a child with chronic constipation |journal=Respir Med Case Rep |volume=21 |issue= |pages=21–24 |date=2017 |pmid=28348950 |pmc=5358970 |doi=10.1016/j.rmcr.2017.03.009 |url=}}</ref>
**[[Methaemoglobin|Methemoglobin]]
**[[Methaemoglobin|Methemoglobin]]
**[[Sulfhemoglobinemia|Sulfhemoglobin]]
**[[Sulfhemoglobinemia|Sulfhemoglobin]]
**[[Polycythemia]]
**[[Polycythemia]]
*[[Raynaud's phenomenon]]
*[[Raynaud's phenomenon]]<ref name="pmid2375536">{{cite journal |vauthors=Engelhart M, Seibold JR |title=Cyanosis and Raynaud's phenomenon: the relation to underlying disease and venous abnormalities |journal=Angiology |volume=41 |issue=6 |pages=432–8 |date=June 1990 |pmid=2375536 |doi=10.1177/000331979004100603 |url=}}</ref>
*[[Altered mental status]]
*[[Altered mental status]]
*Side effects of pharmacotherapy:
*Side effects of pharmacotherapy:<ref name="pmid18456031">{{cite journal |vauthors=Weatherald J, Marrie TJ |title=Pseudocyanosis: drug-induced skin hyperpigmentation can mimic cyanosis |journal=Am. J. Med. |volume=121 |issue=5 |pages=385–6 |date=May 2008 |pmid=18456031 |doi=10.1016/j.amjmed.2008.01.029 |url=}}</ref><ref name="pmid6859496">{{cite journal |vauthors=Hess W, Eberlein HJ, Pöthe H |title=[Cyanosis as a result of drug-induced methemoglobinemia. A case report] |language=German |journal=Anaesthesist |volume=32 |issue=3 |pages=124–6 |date=March 1983 |pmid=6859496 |doi= |url=}}</ref><ref name="pmid29465577">{{cite journal |vauthors=Peng T, Hu Z, Yang X, Gao Y, Ma C |title=Nitrite-induced acute kidney injury with secondary hyperparathyroidism: Case report and literature review |journal=Medicine (Baltimore) |volume=97 |issue=8 |pages=e9889 |date=February 2018 |pmid=29465577 |doi=10.1097/MD.0000000000009889 |url=}}</ref>
**[[Beta blockers]]
**[[Beta blockers]]
**[[Nitrite]] or nitrate-containing compounds (eg, [[nitroglycerin]])
**[[Nitrite]] or nitrate-containing compounds (eg, [[nitroglycerin]])
Line 64: Line 76:
**[[Benzocaine]]
**[[Benzocaine]]
**[[Chloroquine]]
**[[Chloroquine]]
*[[Altitude sickness|High altitude]]
*[[Altitude sickness|High altitude]]<ref name="pmid28613569">{{cite journal |vauthors=Jensen JD, Vincent AL |title= |journal= |volume= |issue= |pages= |date= |pmid=28613569 |doi= |url=}}</ref>
*[[Disseminated intravascular coagulation]]
*[[Disseminated intravascular coagulation]]<ref name="pmid25807263">{{cite journal |vauthors=Busardò FP, Frati P, Zaami S, Fineschi V |title=Amniotic fluid embolism pathophysiology suggests the new diagnostic armamentarium: β-tryptase and complement fractions C3-C4 are the indispensable working tools |journal=Int J Mol Sci |volume=16 |issue=3 |pages=6557–70 |date=March 2015 |pmid=25807263 |pmc=4394548 |doi=10.3390/ijms16036557 |url=}}</ref>
*[[Venemous snake bites|Venomous snake bites]]
*[[Venemous snake bites|Venomous snake bites]]<ref name="pmid25866646">{{cite journal |vauthors=Hifumi T, Sakai A, Kondo Y, Yamamoto A, Morine N, Ato M, Shibayama K, Umezawa K, Kiriu N, Kato H, Koido Y, Inoue J, Kawakita K, Kuroda Y |title=Venomous snake bites: clinical diagnosis and treatment |journal=J Intensive Care |volume=3 |issue=1 |pages=16 |date=2015 |pmid=25866646 |pmc=4393627 |doi=10.1186/s40560-015-0081-8 |url=}}</ref>
*Vaso occlusive crisis ([[Acute chest syndrome]])
*Arterial obstruction:
*Arterial obstruction:
**[[Peripheral arterial disease|Peripheral vascular disease]]
**[[Peripheral arterial disease|Peripheral vascular disease]]
**[[Buergers disease]]
**[[Buergers disease]]
*Venous obstruction:
*Venous obstruction:
**[[Thromboembolism]]
**[[Thromboembolism]]<ref name="pmid21276318">{{cite journal |vauthors=Lepper PM, Ott SR, Hoppe H, Schumann C, Stammberger U, Bugalho A, Frese S, Schmücking M, Blumstein NM, Diehm N, Bals R, Hamacher J |title=Superior vena cava syndrome in thoracic malignancies |journal=Respir Care |volume=56 |issue=5 |pages=653–66 |date=May 2011 |pmid=21276318 |doi=10.4187/respcare.00947 |url=}}</ref>
**[[Deep vein thrombosis]]
**[[Deep vein thrombosis]]
**[[Superior vena cava syndrome]]
**[[Superior vena cava syndrome]]
Line 83: Line 94:
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
 
[[Category:Primary care]]
{{WH}}
{{WS}}
[[Category: (name of the system)]]

Latest revision as of 04:09, 26 December 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]

Overview

Cyanosis is the sign of underlying disease. Risk factors related to the presence of underlying conditions should be noticed. Common risk factors in the development of congenital heart diseases with the right to left shunt include maternal age >35 years, No intake of the multivitamin, febrile illness in the first trimester, obesity, paternal age> 25 years.

Risk Factors

The risk factors for cyanosis include:


References

  1. ↑ Blumenthal I (June 2001). "Carbon monoxide poisoning". J R Soc Med. 94 (6): 270–2. PMC 1281520. PMID 11387414.
  2. ↑ Dueñas-Laita A, Burillo Putze G, Alonso JR, Bajo A, Climent B, Corral E, Felices F, Ferrer A, Hernández Frutos MP, Nogué S, Puiguriguer J (December 2010). "[Basis for the clinical management of fire smoke poisoning "Docohumo Madrid 2010"]". Med Intensiva (in Spanish; Castilian). 34 (9): 609–19. doi:10.1016/j.medin.2010.07.007. PMID 21051109.
  3. ↑ Zoorob RJ, Campbell JS (November 2003). "Acute dyspnea in the office". Am Fam Physician. 68 (9): 1803–10. PMID 14620600.
  4. ↑ Ranjit MS (March 2000). "Cardiac abnormalities in birth asphyxia". Indian J Pediatr. 67 (3 Suppl): S26–9. PMID 11129917.
  5. ↑ Kondamudi NP, Dulebohn SC. PMID 28722923. Missing or empty |title= (help)
  6. ↑ Kondamudi NP, Virji M. PMID 28722926. Missing or empty |title= (help)
  7. ↑ Choi WI (March 2014). "Pneumothorax". Tuberc Respir Dis (Seoul). 76 (3): 99–104. doi:10.4046/trd.2014.76.3.99. PMC 3982243. PMID 24734096.
  8. ↑ FRASER RS, SPROULE BJ, DVORKIN J (December 1963). "HYPOVENTILATION, CYANOSIS AND POLYCYTHEMIA IN A THIN MAN". Can Med Assoc J. 89: 1178–82. PMC 1922100. PMID 14091905.
  9. ↑ Garvey C, Ortiz G (2012). "Exacerbations of chronic obstructive pulmonary disease". Open Nurs J. 6: 13–9. doi:10.2174/1874434601206010013. PMC 3282915. PMID 22393337.
  10. ↑ Wang RF, Hung TY, Chong CF, Wang TL, Chen CC (February 2008). "Central cyanosis due to severe pulmonary hypertension combined with pericarditis as the initial manifestation of systemic lupus erythematosus". Am J Emerg Med. 26 (2): 248.e1–2. doi:10.1016/j.ajem.2007.04.007. PMID 18272123.
  11. ↑ Grech V, Goldman A (November 2001). "Acute respiratory distress syndrome due to cyanotic spell in an infant with tetralogy of Fallot". Pediatr. Pulmonol. 32 (5): 406–7. PMID 11596167.
  12. ↑ Kosacka M, Brzecka A, Jankowska R, Lewczuk J, Mroczek E, Weryńska B (2009). "[Combined pulmonary fibrosis and emphysema - case report and literature review]". Pneumonol Alergol Pol (in Polish). 77 (2): 205–10. PMID 19462358.
  13. ↑ Stadie WC (September 1919). "THE OXYGEN OF THE ARTERIAL AND VENOUS BLOOD IN PNEUMONIA AND ITS RELATION TO CYANOSIS". J. Exp. Med. 30 (3): 215–40. PMC 2126679. PMID 19868355.
  14. ↑ Muhe L (1996). "Managing pneumonia". Child Health Dialogue (3–4): 13. PMID 12292168.
  15. ↑ Angerio AD, Kot PA (November 1994). "Pathophysiology of pulmonary edema". Crit Care Nurs Q. 17 (3): 21–6. PMID 8000933.
  16. ↑ Martins P, Castela E (October 2008). "Transposition of the great arteries". Orphanet J Rare Dis. 3: 27. doi:10.1186/1750-1172-3-27. PMC 2577629. PMID 18851735.
  17. ↑ POTTS WJ (February 1953). "[Congenital heart disease cyanotic children]". Calif Med (in Undetermined). 78 (2): 101–3. PMC 1521678. PMID 13019603.
  18. ↑ Just-Viera JO, Norwood T, Yeager GH (April 1967). "Importance of shock and cyanosis in pulmonary embolism". Ann. Surg. 165 (4): 528–35. PMC 1617449. PMID 6021453.
  19. ↑ Whelan JF (May 1984). "Methemoglobin as a cause of cyanosis". Can Med Assoc J. 130 (10): 1260. PMC 1483499. PMID 6722683.
  20. ↑ George A, Goetz D (2017). "A case of sulfhemoglobinemia in a child with chronic constipation". Respir Med Case Rep. 21: 21–24. doi:10.1016/j.rmcr.2017.03.009. PMC 5358970. PMID 28348950.
  21. ↑ Engelhart M, Seibold JR (June 1990). "Cyanosis and Raynaud's phenomenon: the relation to underlying disease and venous abnormalities". Angiology. 41 (6): 432–8. doi:10.1177/000331979004100603. PMID 2375536.
  22. ↑ Weatherald J, Marrie TJ (May 2008). "Pseudocyanosis: drug-induced skin hyperpigmentation can mimic cyanosis". Am. J. Med. 121 (5): 385–6. doi:10.1016/j.amjmed.2008.01.029. PMID 18456031.
  23. ↑ Hess W, Eberlein HJ, Pöthe H (March 1983). "[Cyanosis as a result of drug-induced methemoglobinemia. A case report]". Anaesthesist (in German). 32 (3): 124–6. PMID 6859496.
  24. ↑ Peng T, Hu Z, Yang X, Gao Y, Ma C (February 2018). "Nitrite-induced acute kidney injury with secondary hyperparathyroidism: Case report and literature review". Medicine (Baltimore). 97 (8): e9889. doi:10.1097/MD.0000000000009889. PMID 29465577.
  25. ↑ Jensen JD, Vincent AL. PMID 28613569. Missing or empty |title= (help)
  26. ↑ Busardò FP, Frati P, Zaami S, Fineschi V (March 2015). "Amniotic fluid embolism pathophysiology suggests the new diagnostic armamentarium: β-tryptase and complement fractions C3-C4 are the indispensable working tools". Int J Mol Sci. 16 (3): 6557–70. doi:10.3390/ijms16036557. PMC 4394548. PMID 25807263.
  27. ↑ Hifumi T, Sakai A, Kondo Y, Yamamoto A, Morine N, Ato M, Shibayama K, Umezawa K, Kiriu N, Kato H, Koido Y, Inoue J, Kawakita K, Kuroda Y (2015). "Venomous snake bites: clinical diagnosis and treatment". J Intensive Care. 3 (1): 16. doi:10.1186/s40560-015-0081-8. PMC 4393627. PMID 25866646.
  28. ↑ Lepper PM, Ott SR, Hoppe H, Schumann C, Stammberger U, Bugalho A, Frese S, Schmücking M, Blumstein NM, Diehm N, Bals R, Hamacher J (May 2011). "Superior vena cava syndrome in thoracic malignancies". Respir Care. 56 (5): 653–66. doi:10.4187/respcare.00947. PMID 21276318.
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