Cyanosis causes: Difference between revisions

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__NOTOC__
__NOTOC__
{{Cyanosis}}
{{Cyanosis}}
{{CMG}}; {{AE}} {{CK}}
{{CMG}}; {{AE}} {{CK}}  


==Overview==
==Overview==
Cyanosis occur because of lack of oxygen in the blood and often due to a circulatory or ventilatory problem that leads to poor blood oxygenation in the lungs (central cyanosis) or due to inadequate circulation to the extremities (peripheral cyanosis).  Cyanosis is commonly caused by respiratory disorders and it is also seen in a wide variety of cardiac and vascular disorders and the management depends on the causative factor.
In [[central cyanosis]] saturation of [[oxygen]] is less than 85% when there is reduced hemoglobin more than 5g/dl following a [[intrapulmonary shunt]] or [[intracardiac shunt]] leading to mixing of arterial and venous [[ oxygen]] content. In [[peripheral cyanosis]], the saturation of [[oxygen]] is normal and there is [[peripheral capillary bed]] [[vasoconstriction]] due to low [[cardiac output]] state or [[sepsis]].


==Causes==
==Causes==
[[Cyanosis]] can be caused by the following mechanisms, systemic arterial oxygen desaturation and increased oxygen extraction by the tissues. Based on these mechanisms, cyanosis can be either central or peripheral. Certain conditions present with bluish purple discoloration of skin or mucous membranes can mimic cyanosis, are not associated with [[hypoxemia]] or peripheral vasoconstriction and is called Pseudocyanosis.


===Common causes:===
 
====Central cyanosis:====
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
*[[Carbon monoxide poisoning]]<ref name="pmid19445736">{{cite journal |vauthors=Olson K, Smollin C |title=Carbon monoxide poisoning (acute) |journal=BMJ Clin Evid |volume=2008 |issue= |pages= |date=July 2008 |pmid=19445736 |pmc=2907971 |doi= |url=}}</ref>
*[[Cyanide poisoning]]<ref name="pmid29417853">{{cite journal |vauthors=Parker-Cote JL, Rizer J, Vakkalanka JP, Rege SV, Holstege CP |title=Challenges in the diagnosis of acute cyanide poisoning |journal=Clin Toxicol (Phila) |volume= |issue= |pages=1–9 |date=February 2018 |pmid=29417853 |doi=10.1080/15563650.2018.1435886 |url=}}</ref>
*[[Malathion]]
*[[Parathion]]
*[[Ethylene glycol]]
*[[Epiglottitis]]
*[[Foreign body aspiration]]<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>
*[[Pulmonary embolism]]<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>
*[[Tension pneumothorax]]<ref name="pmid10407699">{{cite journal |vauthors=Barton ED |title=Tension pneumothorax |journal=Curr Opin Pulm Med |volume=5 |issue=4 |pages=269–74 |date=July 1999 |pmid=10407699 |doi= |url=}}</ref>
*[[Hemothorax]]
*[[Pulmonary hemorrhage]]
*[[Pulmonary hypertension]]<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>
*[[Myocardial infarction]]
*[[Congestive heart failure]]
*[[Disseminated intravascular coagulation]]<ref name="pmid28722864">{{cite journal |vauthors=Costello RA, Nehring SM |title= |journal= |volume= |issue= |pages= |date= |pmid=28722864 |doi= |url=}}</ref>
*[[Tetralogy of fallot]]<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>
*[[Cardiac tamponade]]<ref name="pmid21716107">{{cite journal |vauthors=Bodson L, Bouferrache K, Vieillard-Baron A |title=Cardiac tamponade |journal=Curr Opin Crit Care |volume=17 |issue=5 |pages=416–24 |date=October 2011 |pmid=21716107 |doi=10.1097/MCC.0b013e3283491f27 |url=}}</ref>
*[[Eisenmenger syndrome]]<ref name="pmid4173631">{{cite journal |vauthors=Komine S |title=In vitro studies on the degradation and synthesis of serum proteins in placentae. I. Synthesis of serum proteins |journal=Nippon Juigaku Zasshi |volume=26 |issue=1 |pages=15–23 |date=February 1964 |pmid=4173631 |doi= |url=}}</ref>
*[[Anaphylaxis]]
*[[Birth asphyxia]]<ref name="pmid19727322">{{cite journal |vauthors=Steinhorn RH |title=Evaluation and management of the cyanotic neonate |journal=Clin Pediatr Emerg Med |volume=9 |issue=3 |pages=169–175 |date=September 2008 |pmid=19727322 |pmc=2598396 |doi=10.1016/j.cpem.2008.06.006 |url=}}</ref>
*[[Amniotic fluid embolism]]<ref name="pmid27275041">{{cite journal |vauthors=Kaur K, Bhardwaj M, Kumar P, Singhal S, Singh T, Hooda S |title=Amniotic fluid embolism |journal=J Anaesthesiol Clin Pharmacol |volume=32 |issue=2 |pages=153–9 |date= 2016 |pmid=27275041 |pmc=4874066 |doi=10.4103/0970-9185.173356 |url=}}</ref>
 
===Common Causes===
====Central Cyanosis====
There following are some of the common causes of central cyanosis:
There following are some of the common causes of central cyanosis:
*'''Pulmonary causes''':
*'''Conditions associated with decreased concentration of inspired oxygen (FiO2):'''<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>
**'''Conditions associated with decreased concentration of inspired oxygen (FiO2):'''<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>
**[[Smoke inhalation]] most commonly from house fires
***[[Smoke inhalation]] most commonly from house fires
**[[Carbon monoxide poisoning]]
***[[Carbon monoxide poisoning]]
**Hydrogen [[cyanide poisoning]]
***Hydrogen [[cyanide poisoning]]
**Intentional or unintentional exposure to asphyxiating gases (eg, [[Propane]], [[methane]], [[Butane|butane,]] [[Hydrogen sulfide|hydrogen sulphide]])
***Intentional or unintensional exposure to asphyxiating gases (eg, [[Propane]], [[methane]], [[Butane|butane,]] [[Hydrogen sulfide|hydrogen sulphide]])
*'''Impairment of chest wall or lung expansion:'''
**'''Impairment of chest wall or lung expansion:'''
**External compression
***External compression
**[[Pneumothorax]]<ref name="pmid29083723">{{cite journal |vauthors=Costumbrado J, Ghassemzadeh S |title= |journal= |volume= |issue= |pages= |date= |pmid=29083723 |doi= |url=}}</ref>
***[[Pneumothorax]]<ref name="pmid29083723">{{cite journal |vauthors=Costumbrado J, Ghassemzadeh S |title= |journal= |volume= |issue= |pages= |date= |pmid=29083723 |doi= |url=}}</ref>
**[[Hemothorax]]
***[[Hemothorax]]
**[[Flail chest]]
***[[Flail chest]]
*'''Hypoventilation:'''
**'''Hypoventilation:'''
**'''Upper airway obstruction:''' <ref name="pmid29261942">{{cite journal |vauthors=Gossman WG, Burns B |title= |journal= |volume= |issue= |pages= |date= |pmid=29261942 |doi= |url=}}</ref><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>
***'''Upper airway obstruction:''' <ref name="pmid29261942">{{cite journal |vauthors=Gossman WG, Burns B |title= |journal= |volume= |issue= |pages= |date= |pmid=29261942 |doi= |url=}}</ref><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>
***[[Foreign body aspiration]]
****[[Foreign body aspiration]]
***[[Pertussis]] / [[Croup]]
****[[Pertussis]] / [[Croup]]
***[[Epiglottitis]]
****[[Epiglottitis]]
***[[Tracheitis|Bacterial tracheitis]]
****[[ Bacterial tracheitis]]  
***Traumatic disruption (thermal injury, fractures)
****[[Perinatal asphyxia|Birth asphyxia]]
***[[Acute chest syndrome]]<ref name="pmid29279787">{{cite journal |vauthors=Jain S, Bakshi N, Krishnamurti L |title=Acute Chest Syndrome in Children with Sickle Cell Disease |journal=Pediatr Allergy Immunol Pulmonol |volume=30 |issue=4 |pages=191–201 |date=December 2017 |pmid=29279787 |pmc=5733742 |doi=10.1089/ped.2017.0814 |url=}}</ref>
****Traumatic disruption (Thermal injury, fractures)
***Congenital airway abnormalities:
****Congenital airway abnormalities:
****[[Choanal atresia]]
*****[[Choanal atresia]]
****[[Laryngotracheomalacia]]
*****[[Laryngotracheomalacia]]
****[[Macroglossia]]
*****[[Macroglossia]]
****[[Micrognathia]] or [[Retrognathism|retrognathia]] (eg, Pierre-Robin syndrome)
*****[[Micrognathia]] or [[Retrognathism|retrognathia]] (eg, Pierre-Robin syndrome)
**'''Neurologic abnormalities:'''<ref name="pmid28722923">{{cite journal |vauthors=Kondamudi NP, Dulebohn SC |title= |journal= |volume= |issue= |pages= |date= |pmid=28722923 |doi= |url=}}</ref><ref name="pmid28722998">{{cite journal |vauthors=Kondamudi NP, Wilt AS |title= |journal= |volume= |issue= |pages= |date= |pmid=28722998 |doi= |url=}}</ref><ref name="pmid28722938">{{cite journal |vauthors=Memon J, Manganaro SN |title= |journal= |volume= |issue= |pages= |date= |pmid=28722938 |doi= |url=}}</ref>
**'''Ventilation/perfusion mismatch:'''<ref name="pmid8575588">{{cite journal |vauthors=Maitre B, Similowski T, Derenne JP |title=Physical examination of the adult patient with respiratory diseases: inspection and palpation |journal=Eur. Respir. J. |volume=8 |issue=9 |pages=1584–93 |date=September 1995 |pmid=8575588 |doi= |url=}}</ref><ref name="pmid26760414">{{cite journal |vauthors=Hermansen CL, Mahajan A |title=Newborn Respiratory Distress |journal=Am Fam Physician |volume=92 |issue=11 |pages=994–1002 |date=December 2015 |pmid=26760414 |doi= |url=}}</ref>
***[[CNS depression]]
***[[Asthma]]
***[[Birth asphyxia]]
***[[Pulmonary embolism]]
***Severe head trauma
***[[Atelectasis]]
***[[Apnea of prematurity]]
***[[Alveolar capillary dysplasia]]
***[[Obstructive sleep apnea]]
***[[emphysema]] or [[Chronic obstructive pulmonary disease|COPD]]
***Infections (eg, [[meningitis]], [[encephalitis]])
***[[Pulmonary edema]]
***[[Intraventricular hemorrhage]]
***Pulmonary hypoplasia
***[[Seizure|Seizures]]
***[[Pulmonary hemorrhage]]
***Cyanotic breath holding spells<ref name="pmid28555179">{{cite journal |vauthors=Bergeron M, Cohen AP, Cotton RT |title=The Management of Cyanotic Spells in Children with Oesophageal Atresia |journal=Front Pediatr |volume=5 |issue= |pages=106 |date= 2017 |pmid=28555179 |pmc=5430373 |doi=10.3389/fped.2017.00106 |url=}}</ref>
***[[Acute respiratory distress syndrome|Respiratory distress syndrome]] (Hyaline membrane disease)
***[[Coma]]
***[[Transient tachypnea of the newborn]]
**'''Neuromuscular disorders:'''
**'''Conditions causing impaired oxygen diffusion:'''
***[[Myasthenia gravis]]
***[[Pulmonary fibrosis]]
***Injury to the phrenic nerve
***[[Pulmonary edema]]
***Type 1 spinal muscular dystrophy (Wernig-Hoffman disease)
**'''Intrinsic lung diseases''':<ref name="pmid28722988">{{cite journal |vauthors=Justice NA, Le JK |title= |journal= |volume= |issue= |pages= |date= |pmid=28722988 |doi= |url=}}</ref>
*'''Intrinsic lung diseases''':<ref name="pmid8575588">{{cite journal |vauthors=Maitre B, Similowski T, Derenne JP |title=Physical examination of the adult patient with respiratory diseases: inspection and palpation |journal=Eur. Respir. J. |volume=8 |issue=9 |pages=1584–93 |date=September 1995 |pmid=8575588 |doi= |url=}}</ref><ref name="pmid26760414">{{cite journal |vauthors=Hermansen CL, Mahajan A |title=Newborn Respiratory Distress |journal=Am Fam Physician |volume=92 |issue=11 |pages=994–1002 |date=December 2015 |pmid=26760414 |doi= |url=}}</ref><ref name="pmid21471096">{{cite journal |vauthors=Bishop NB, Stankiewicz P, Steinhorn RH |title=Alveolar capillary dysplasia |journal=Am. J. Respir. Crit. Care Med. |volume=184 |issue=2 |pages=172–9 |date=July 2011 |pmid=21471096 |pmc=3172887 |doi=10.1164/rccm.201010-1697CI |url=}}</ref><ref name="pmid28722988">{{cite journal |vauthors=Justice NA, Le JK |title= |journal= |volume= |issue= |pages= |date= |pmid=28722988 |doi= |url=}}</ref><ref name="pmid25274969">{{cite journal |vauthors=Reuter S, Moser C, Baack M |title=Respiratory distress in the newborn |journal=Pediatr Rev |volume=35 |issue=10 |pages=417–28; quiz 429 |date=October 2014 |pmid=25274969 |pmc=4533247 |doi=10.1542/pir.35-10-417 |url=}}</ref>
***[[Pneumonia]]
**[[Asthma]]
***[[Bronchiolitis]]
**[[COPD]]
***[[Bronchopulmonary dysplasia]]
**[[Pneumonia]]
***[[Cystic fibrosis]]
**[[Bronchiolitis]]
***[[Empyema]]
**[[Acute respiratory distress syndrome|Respiratory distress syndrome]] (Hyaline membrane disease)
***[[Pleural effusion]]
**[[Empyema]]
*'''Vascular causes:'''
**[[Pleural effusion]]
**[[Cystic fibrosis]]
**[[Atelectasis]]
**[[Bronchopulmonary dysplasia]]
**[[Alveolar capillary dysplasia]]
*'''Vascular causes''':
**[[Cardiac tamponade]]
**[[Cardiac tamponade]]
**'''Cyanotic congenital heart diseases (Right to left shunts):'''<ref name="pmid16199347">{{cite journal |vauthors=Woods WA, McCulloch MA |title=Cardiovascular emergencies in the pediatric patient |journal=Emerg. Med. Clin. North Am. |volume=23 |issue=4 |pages=1233–49 |date=November 2005 |pmid=16199347 |doi=10.1016/j.emc.2005.07.003 |url=}}</ref><ref name="pmid2407997">{{cite journal |vauthors=Driscoll DJ |title=Evaluation of the cyanotic newborn |journal=Pediatr. Clin. North Am. |volume=37 |issue=1 |pages=1–23 |date=February 1990 |pmid=2407997 |doi= |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>
**'''Cyanotic congenital heart diseases (Right to left shunts):'''<ref name="pmid16199347">{{cite journal |vauthors=Woods WA, McCulloch MA |title=Cardiovascular emergencies in the pediatric patient |journal=Emerg. Med. Clin. North Am. |volume=23 |issue=4 |pages=1233–49 |date=November 2005 |pmid=16199347 |doi=10.1016/j.emc.2005.07.003 |url=}}</ref><ref name="pmid2407997">{{cite journal |vauthors=Driscoll DJ |title=Evaluation of the cyanotic newborn |journal=Pediatr. Clin. North Am. |volume=37 |issue=1 |pages=1–23 |date=February 1990 |pmid=2407997 |doi= |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>
***'''Decreased pulmonary flow:'''
***'''Decreased pulmonary flow:'''
****[[Tetralogy of Fallot|Tetralogy of fallot]]
****[[Tetralogy of Fallot|Tetralogy of fallot]]<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>
****Tricuspid valve anomalies:
****Tricuspid valve anomalies:
*****[[Tricuspid atresia]]
*****[[Tricuspid atresia]]
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****[[Truncus arteriosus]]
****[[Truncus arteriosus]]
****[[Total anomalous pulmonary venous connection|TAPVC]] (Total anamalous pulmonary venous connection)
****[[Total anomalous pulmonary venous connection|TAPVC]] (Total anamalous pulmonary venous connection)
***'''Heart failure:'''  Condition that present with cyanosis and  severe heart failure include:
***'''Heart failure:'''  Conditions that present with cyanosis and  severe heart failure include:
****Left sided obstructive lesion ([[Hypoplastic left heart syndrome|HLHS]])
****Left sided obstructive lesion ([[Hypoplastic left heart syndrome|HLHS]])
****[[Aortic coarctation|Coarctation of aorta]]
****[[Aortic coarctation|Coarctation of aorta]]
****Critical valvular [[aortic stenosis]]
****Critical valvular [[aortic stenosis]]
**[[Eisenmenger's syndrome|Eisenmenger syndrome]]
**[[Eisenmenger's syndrome|Eisenmenger syndrome]]
**[[congestive heart failure]]
**[[Congestive heart failure]]
**[[Atrial septal defect]]
**[[Atrial septal defect]]
**[[Pulmonary hypertension]]
**[[Pulmonary hypertension]]
Line 84: Line 112:
**[[Pulmonary hemorrhage]]
**[[Pulmonary hemorrhage]]
**[[Pulmonary embolism]]
**[[Pulmonary embolism]]
**[[pulmonary arteriovenous malformation]]
**Pulmonary arteriovenous malformations
**Multiple small intrapulmonary shunts
**Multiple small intrapulmonary shunts
**[[Shock]]
**[[Shock]]
Line 92: Line 120:
**[[Methemoglobinemia]] (congenital or acquired)
**[[Methemoglobinemia]] (congenital or acquired)
**[[Sulfhemoglobinemia]] (acquired)
**[[Sulfhemoglobinemia]] (acquired)
**Hemoglobin mutations with low oxygen affinity: Hb Kansas,  Hb Beth israel, Hb Saint Mande, Hb Bruxells
**Hemoglobin mutations with low oxygen affinity:
***Hb Kansas
***Hb Beth Israel
***Hb Saint Mande
***Hb Bruxells
**[[Polycythemia vera]]
**[[Polycythemia vera]]
**[[Disseminated intravascular coagulation]]
**[[Disseminated intravascular coagulation]]
*'''Neurologic abnormalities:'''<ref name="pmid28722923">{{cite journal |vauthors=Kondamudi NP, Dulebohn SC |title= |journal= |volume= |issue= |pages= |date= |pmid=28722923 |doi= |url=}}</ref><ref name="pmid28722998">{{cite journal |vauthors=Kondamudi NP, Wilt AS |title= |journal= |volume= |issue= |pages= |date= |pmid=28722998 |doi= |url=}}</ref><ref name="pmid28722938">{{cite journal |vauthors=Memon J, Manganaro SN |title= |journal= |volume= |issue= |pages= |date= |pmid=28722938 |doi= |url=}}</ref>
**[[CNS depression]]
**[[Birth asphyxia]]
**Severe head trauma
**[[Apnea of prematurity]]
**[[Obstructive sleep apnea]]
**Infections (eg, [[meningitis]], [[encephalitis]])
**[[Intraventricular hemorrhage]]
**[[Seizure|Seizures]]
**Cyanotic breath holding spells
**[[Coma]]
*'''Neuromuscular disorders:'''
**[[Myasthenia gravis]]
**Injury to the phrenic nerve
**Type 1 spinal muscular dystrophy (Wernig-Hoffman disease)
*'''Metabolic disorders:'''
*'''Metabolic disorders:'''
**Severe [[hypoglycemia]]
**Severe [[hypoglycemia]]
**In born errors of metabolism
**[[Inborn error of metabolism|Inborn errors of metabolism]]
*'''Miscellaneous''':
*'''Miscellaneous''':
**Drugs and chemicals:<ref name="pmid29171648">{{cite journal |vauthors=Günal E, Akkuş Y, Çığşar G, Çiftçi H, Kahramanca Ş, Özdemir M |title=Methemoglobinemia incidence after the application of lidocaine for small surgical procedures |journal=Agri |volume=29 |issue=4 |pages=173–176 |date=October 2017 |pmid=29171648 |doi= |url=}}</ref><ref name="pmid15249969">{{cite journal |vauthors=Hilbert P, Zur Nieden K |title=[Suicidal fatal beta-blocker intoxication] |language=German |journal=Anaesthesist |volume=53 |issue=9 |pages=826–9 |date=September 2004 |pmid=15249969 |doi=10.1007/s00101-004-0721-1 |url=}}</ref>
**[[:Category:Drugs|Drugs]] and [[Chemical substance|chemicals]]:<ref name="pmid29171648">{{cite journal |vauthors=Günal E, Akkuş Y, Çığşar G, Çiftçi H, Kahramanca Ş, Özdemir M |title=Methemoglobinemia incidence after the application of lidocaine for small surgical procedures |journal=Agri |volume=29 |issue=4 |pages=173–176 |date=October 2017 |pmid=29171648 |doi= |url=}}</ref><ref name="pmid15249969">{{cite journal |vauthors=Hilbert P, Zur Nieden K |title=[Suicidal fatal beta-blocker intoxication] |language=German |journal=Anaesthesist |volume=53 |issue=9 |pages=826–9 |date=September 2004 |pmid=15249969 |doi=10.1007/s00101-004-0721-1 |url=}}</ref>
***[[Beta blockers]]
***[[Beta blockers]]
***[[Nitrite]] or nitrate-containing compounds (eg, nitroglycerin)
***[[Nitrite]] or nitrate-containing compounds (eg, [[nitroglycerin]])
***[[Dapsone]]
***[[Dapsone]]
***[[sulfonamides]]
***[[Sulfonamides]]
***[[Benzocaine]]
***[[Benzocaine]]
***[[chloroquine]]
***[[Chloroquine]]
***[[Heroin]]
***[[Heroin]]
***Venomous [[snakebites]]<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>
**Venomous [[snakebites]]<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>
**[[Acute chest syndrome]]<ref name="pmid29279787">{{cite journal |vauthors=Jain S, Bakshi N, Krishnamurti L |title=Acute Chest Syndrome in Children with Sickle Cell Disease |journal=Pediatr Allergy Immunol Pulmonol |volume=30 |issue=4 |pages=191–201 |date=December 2017 |pmid=29279787 |pmc=5733742 |doi=10.1089/ped.2017.0814 |url=}}</ref>
**Brief resolved unexplained events (BRUE)<ref name="pmid28722926">{{cite journal |vauthors=Kondamudi NP, Virji M |title= |journal= |volume= |issue= |pages= |date= |pmid=28722926 |doi= |url=}}</ref>
**Brief resolved unexplained events (BRUE)<ref name="pmid28722926">{{cite journal |vauthors=Kondamudi NP, Virji M |title= |journal= |volume= |issue= |pages= |date= |pmid=28722926 |doi= |url=}}</ref>
**[[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>
**[[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>
**[[congenital diaphragmatic hernia]]
**[[Congenital diaphragmatic hernia]]
**[[cirrhosis of liver]]
**[[Cirrhosis of liver]]
**[[Drowning]]
**[[Drowning]]
**Chocking
**Chocking
**Hanging
**Hanging
**[[Hypothermia]]
**[[Hypothermia]]
====Peripheral Cyanosis:====
====Peripheral Cyanosis:====
There following are some of the Common causes of Peripheral Cyanosis: <ref name="pmid27899893">{{cite journal |vauthors=Fardoun MM, Nassif J, Issa K, Baydoun E, Eid AH |title=Raynaud's Phenomenon: A Brief Review of the Underlying Mechanisms |journal=Front Pharmacol |volume=7 |issue= |pages=438 |date= 2016 |pmid=27899893 |pmc=5110514 |doi=10.3389/fphar.2016.00438 |url= |author=}}</ref> <ref name="pmid24249890">{{cite journal |vauthors=Das S, Maiti A |title=Acrocyanosis: an overview |journal=Indian J Dermatol |volume=58 |issue=6 |pages=417–20 |date=November 2013 |pmid=24249890 |pmc=3827510 |doi=10.4103/0019-5154.119946 |url= |author=}}</ref>
There following are some of the common causes of peripheral cyanosis: <ref name="pmid27899893">{{cite journal |vauthors=Fardoun MM, Nassif J, Issa K, Baydoun E, Eid AH |title=Raynaud's Phenomenon: A Brief Review of the Underlying Mechanisms |journal=Front Pharmacol |volume=7 |issue= |pages=438 |date= 2016 |pmid=27899893 |pmc=5110514 |doi=10.3389/fphar.2016.00438 |url= |author=}}</ref><ref name="pmid24249890">{{cite journal |vauthors=Das S, Maiti A |title=Acrocyanosis: an overview |journal=Indian J Dermatol |volume=58 |issue=6 |pages=417–20 |date=November 2013 |pmid=24249890 |pmc=3827510 |doi=10.4103/0019-5154.119946 |url= |author=}}</ref>
*Various conditions that cause central cyanosis can also cause peripheral cyanosis.
*Various conditions that cause central cyanosis can also present with peripheral cyanosis.
**[[Asthma]]
*Common conditions where peripheral cyanosis is more specific:
**[[Emphysema]]
**[[Hypothermia|Cold exposure]]
**[[Chronic obstructive pulmonary disease]]
**[[Acrocyanosis]]
**[[Congenital heart disease]]
**[[Erythrocyanosis]]
**[[Tetralogy of fallot]]
**[[Raynaud's phenomenon]]
**[[Heart failure]]
**[[Raynaud's disease]]
**[[High altitude]]
**Arterial obstruction:
**[[Methemoglobinemia]]
***[[Peripheral arterial disease|Peripheral vascular disease]]
**[[Polycythemia vera]]
***[[Buergers disease]]
**[[Pulmonary embolism]]
**Venous obstruction:
*[[Hypothermia|Cold exposure]]
***[[Thromboembolism]]
*Decreased cardiac output  
***[[Deep vein thrombosis]]  
**[[Congestive heart failure|Left sided heart failure]]
***[[Superior vena cava syndrome]]
**[[shock]]
**Decreased cardiac output:
**[[hypovolemia]]
***[[Congestive heart failure|Left-sided heart failure]]
*[[Acrocyanosis]]
***[[Shock]]
*[[Erythrocyanosis]]
***[[Hypovolemia]]
*[[Raynaud's phenomenon]]
**Redistribution of blood flow from extremities
*[[Raynaud's disease]]
*Arterial obstruction [[Peripheral arterial disease|(Peripheral vascular disease]], [[Buergers disease]])
*Venous obstruction ([[Thromboembolism]], [[Deep vein thrombosis]], [[Superior vena cava syndrome]])
*Redistribution of blood flow from extremities


====Pseudocyanosis====
====Pseudocyanosis:====
*Metals (eg, [[silver nitrate]], [[silver iodide]], [[silver]], [[lead]])
*Metals:
*Drugs (eg, [[Phenothiazine|phenothiazines]], [[amiodarone]], [[Chloroquine|chloroquine hydrochloride]])
**[[Silver nitrate]]
**[[Silver iodide]]  
**[[Silver]]  
**[[Lead]]
*Drugs:
**[[Phenothiazine|Phenothiazines]]
**[[Amiodarone]]  
**[[Chloroquine|Chloroquine hydrochloride]]
*Pigmentary lesions (eg, [[Mongolian spot]]<nowiki/>s, large birthmarks)
*Pigmentary lesions (eg, [[Mongolian spot]]<nowiki/>s, large birthmarks)
*Tattoos
*Extensive tattoos
*Consumption of blue- or purple-dyed food
*Consumption of blue or purple-dyed food
 
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
*[[Carbon monoxide poisoning]]
*[[Cyanide poisoning]]
*[[Malathion]]
*[[Parathion]]
*[[Ethylene glycol]]
*[[Epiglottitis]]
*[[Foreign body aspiration]]
*[[Pulmonary embolism]]
*[[Tension pneumothorax]]
*[[Hemothorax]]
*[[Pulmonary hemorrhage]]
*[[Pulmonary hypertension]]
*[[Myocardial infarction]]
*[[Congestive heart failure]]
*[[Disseminated intravascular coagulation]]
*[[Tetralogy of fallot]]
*[[Cardiac tamponade]]
*[[Eisenmenger syndrome]]
*[[Anaphylaxis]]
*[[Birth asphyxia]]
*[[Amniotic fluid embolism]]
 


===Causes by Organ System===
===Causes by Organ System===
Line 1,080: Line 1,075:
*[[Whooping cough]]
*[[Whooping cough]]
{{col-end}}
{{col-end}}
===Causes of peripheral cyanosis===
{{columns-list|
*[[Acrocyanosis]]
*[[Buerger's disease]]
*[[Cold exposure]]
*[[Deep vein thrombosis]]
*[[Erythrocyanosis]]
*[[Hypovolemia]]
*[[Left sided heart faiure]]
*[[Peripheral vascular disease]]
*[[Raynaud's disease]]
*[[Raynaud's phenomenon]]
*[[Shock]]
*[[Superior vena cava syndrome]]
*[[Thromboembolism]]
}}


==References==
==References==
Line 1,089: Line 1,102:
[[Category:Physical Examination]]
[[Category:Physical Examination]]
[[Category:Pulmonology]]
[[Category:Pulmonology]]
 
[[Category:Up-To-Date]]
{{WH}}
{{WS}}

Latest revision as of 19:49, 29 January 2021

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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

In central cyanosis saturation of oxygen is less than 85% when there is reduced hemoglobin more than 5g/dl following a intrapulmonary shunt or intracardiac shunt leading to mixing of arterial and venous oxygen content. In peripheral cyanosis, the saturation of oxygen is normal and there is peripheral capillary bed vasoconstriction due to low cardiac output state or sepsis.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Common Causes

Central Cyanosis

There following are some of the common causes of central cyanosis:

Peripheral Cyanosis:

There following are some of the common causes of peripheral cyanosis: [34][35]

Pseudocyanosis:

Causes by Organ System

Cardiovascular Aberrant subclavian artery, acrocyanosis, air embolism, Al Gazali-Aziz-Salem syndrome, alveolar capillary dysplasia , aortic arch defects, aortic coarctation, aortic stenosis, arterial occlusion, atrial myxoma, atrial septal defect, Bindewald-Ulmer-Muller syndrome, Blalock-Taussig shunt, Bland-White-Garland syndrome, blue baby syndrome, Buergers disease, cardiac tamponade, cardiomyopathy, Cassirer disease, cholesterol emboli syndrome, cholesterol pneumonia, congenital heart disease, congestive heart failure, cor biloculare, cor triatriatum, coronary artery anomaly, critical valvular aortic stenosis, Crocq disease, cyanotic congenital heart disease, deep vein thrombosis, double inlet left ventricle, double outlet right ventricle, Ebstein anomaly, Eisenmenger syndrome, familial pulmonary capillary hemangiomatosis, heart attack, hemothorax, hypocalcemia, hypoplastic left heart syndrome, hypovolemia, hypoxemia, idiopathic pulmonary hypertension, intermittent claudication, ischemic heart disease, isolated ventriculoarterial discordance, Ivemark syndrome, Jervell and Lange-Nielsen syndrome, Kugel-Stoloff syndrome, laryngeal edema, malignancy-related superior vena cava syndrome, Marfan syndrome, Meadows syndrome, mitral atresia in infants, myocardial infarction, partial atrioventricular canal, patent ductus arteriosus, patent foramen ovale, peripartum cardiomyopathy, peripheral arterial disease, persistent pulmonary hypertension of the newborn, persistent truncus arteriosus, phlegmasia cerulea dolens, pseudocyanosis, pulmonary arteriovenous fistula, pulmonary arteriovenous malformation, pulmonary embolism, pulmonary hypertension, pulmonary stenosis, pulmonary veno-occlusive disease, pulmonary venous return anomaly, right ventricle hypoplasia, right ventricular outflow tract obstruction, shock, Sneddon syndrome, subpulmonary stenosis, superior vena cava syndrome, TAPVC, Taussig-Bing syndrome, tetralogy of Fallot, total anomalous pulmonary venous connection, transposition of the great vessels, tricuspid atresia, tricuspid stenosis, truncus arteriosus, vascular malposition, vascular rings, velocardiofacial syndrome, ventricular septal defect
Chemical / poisoning 2,4,6-trinitrotoluene, 4-Nitrophenol, anchovy poisoning, aniline, anisidine, antifreeze, apple seed poisoning, apricot seed poisoning, arsine gas, bird cherry seed poisoning, bitter almond seed poisoning, brown snake poisoning, carbamates, chlorate salts, chlorobenzene, chronic mercury exposure, clupeotoxin, cyanide poisoning, demeton-S-methyl, diazinon, dichlorvos, dicrotophos, dinitrocresol, dioxathion, disulfoton, endosulfan, epichlorohydrin, ethion, ethylene glycol, ethylene oxide, ethylene, fensulfothion, fenthion, herring poisoning, hydrogen sulfide, iron poisoning, lantana poisoning, lead, malathion, methidathion, methiocarb, methomyl, organophosphate poisoning, paraquat, parathion, phosdrin, profenofos, propane, sea snake venom, silver iodide, silver nitrate, silver, smoke inhalation, snakebites, stachybotrys chartarum exposure, strychnine, sulfur dioxide, terbufos, tetraethyl pyrophosphate, tetrodotoxin, thioglycolic acid, trichloroethylene
Dermatologic Acrodynia, Al Gazali-Aziz-Salem syndrome, angioneurotic edema, chromhidrosis
Drug Side Effect Acetaminophen and hydrocodone, amiodarone, amyl nitrite, benzocaine, benzodiazepines, beta blockers,bicisate dihydrochloride, bufotenin, chloramphenicol, chloroquine, clonazepam, clorazepate, codeine, dapsone, desmopressin, diazepam, dilaudid, gray baby syndrome, hydrocodone, hydroquinone, ibuprofen, Imipenem-Cilastatin,lorazepam, lortab, maternal sedation, meperidine, methadone, metoclopramide, midazolam, morphine, narcotics, nitrates, nitrazepam, nitrites, nitroglycerin, oxazepam, phenazopyridine, phenol, phenothiazines, primaquine , ribavirin, rifampin, sedatives, sulfonamides
Ear Nose Throat Choanal atresia, epiglottitis, laryngomalacia, laryngotracheomalacia, lethal chondrodysplasia Moerman type, Ludwig's angina, macroglossia, microcephalic osteodysplastic primordial dwarfism type 1, micrognathia, Pierre Robin syndrome, retrognathia, syndromic microphthalmia type 9, vocal cord paralysis, Weinstein Kliman Scully syndrome
Endocrine Adrenal hemorrhage, congenital hyperinsulinism, hypoadrenalism, hypocalcemia, hypoglycemia, hypomagnesemia, pseudoaldosteronism, type 1 pseudohypoaldosteronism, Waterhouse-Friederichsen syndrome, Weinstein Kliman Scully syndrome
Environmental Asbestosis, berylliosis, coal worker's pneumoconiosis, cold exposure, hypersensitivity pneumonitis, insect sting allergy, pneumoconiosis, Shaver's disease, silicosiderosis, silicosis
Gastroenterologic Boerhaave syndrome, Cast syndrome, cirrhosis of liver, congenital diaphragmatic hernia, cystic fibrosis, duodenal atresia, esophageal atresia, tracheal agenesis without tracheoesophageal fistula, tracheoesophageal fistula
Genetic 1p36 deletion syndrome, acrocephalopolysyndactyly, acrofacial dysostosis, benign familial neonatal convulsions, chromosome 22q11 deletion, cystic fibrosis, DiGeorge syndrome, HMG-CoA lyase deficiency, Jervell and Lange-Nielsen syndrome, Marfan syndrome, microcephalic osteodysplastic primordial dwarfism type 1 , Sakati syndrome, Sakati-Nyhan-Tisdale syndrome, Shprintzen syndrome, velocardiofacial syndrome, VLCAD deficiency, Werdnig-Hoffman disease
Hematologic Blood transfusion, cystic hygroma, deep vein thrombosis, disseminated intravascular coagulation, hemoglobinopathy, methemoglobinemia, Osler-Vaquez disease, phlegmasia alba dolens, phlegmasia cerulea dolens, polycythemia vera, pulmonary embolism, sulfhemoglobinemia, Vaquez disease
Iatrogenic Mendelson's syndrome
Infectious Disease Acute histoplasmosis, anthracosis, bacterial tracheitis, bordetella pertussis, epiglottitis, legionellosis, legionnaire's disease, Ludwig's angina, melioidosis, meningitis, pertussis, sepsis, streptococcal group B invasive disease , Waterhouse-Friederichsen syndrome, western equine encephalitis, whooping cough
Musculoskeletal / Ortho Adams–Oliver syndrome, Al Gazali-Aziz-Salem syndrome, Bindewald-Ulmer-Muller syndrome, Isaac's syndrome, lethal chondrodysplasia Moerman type, microcephalic osteodysplastic primordial dwarfism type 1, neuromyotonia, thoracic dystrophy
Neurologic Adams-Oliver syndrome, benign familial neonatal convulsions, Bindewald-Ulmer-Muller syndrome, birth asphyxia, cerebral hypoxia, congenital central hypoventilation syndrome, encephalitis, head trauma, hypoxic ischemic encephalopathy, intracranial hemorrhage, intraventricular hemorrhage, Isaac's syndrome, meningitis, monomelic amyotrophy, mountain sickness, neonatal myasthenia gravis, neuromyotonia, obstructive sleep apnea, perinatal asphyxia, phrenic nerve injury, seizure, sleep apnea, sudden infant death syndrome, suffocation, tonic-clonic seizures, vein of Galen aneurysm, vocal cord paralysis, Werdnig-Hoffman disease, western equine encephalitis
Nutritional / Metabolic Dehydration, diphosphoglycerate mutase deficiency, HMG-CoA lyase deficiency
Obstetric/Gynecologic Meadows syndrome, Mendelson's syndrome, peripartum cardiomyopathy
Oncologic Cystic hygroma, malignancy-related superior vena cava syndrome, Osler-Vaquez disease, Pancoast tumor, polycythemia vera, Vaquez disease
Opthalmologic Matthew-Wood syndrome, Sneddon syndrome, Weinstein Kliman Scully syndrome
Overdose / Toxicity Drug overdose, heroin, phosdrin
Psychiatric Congenital central hypoventilation syndrome, shaken baby syndrome
Pulmonary Acrocyanosis, acute interstitial pneumonitis, air leak syndromes, airway obstruction, alveolar capillary dysplasia, angioneurotic edema, apnea of prematurity, aspiration, asthma, atelectasis, bacterial tracheitis, Besnier-Boeck-Schaumann disease, bronchiectasis, bronchiolitis, bronchopulmonary dysplasia, bronchospasm, Cassirer disease, cholesterol pneumonia, chronic bronchitis, chronic obstructive pulmonary disease, chylothorax, community-acquired pneumonia, congenital central hypoventilation syndrome, congenital cystic adenomatoid malformation, congenital pulmonary lymphangiectasia, Crocq disease, croup, cystic fibrosis, diaphragmatic paralysis, emphysema, empyema, epiglottitis, erythrocyanosis, exercise-induced asthma, extrinsic allergic alveolitis, familial interstitial fibrosis , familial pulmonary capillary hemangiomatosis, fibrosing alveolitis, flail chest, foreign body aspiration, Hamman-Rich syndrome , hemothorax, hyaline membrane disease, hypersensitivity pneumonitis, hypoventilation, hypoxemia, hypoxia (medical), idiopathic diffuse interstitial pulmonary fibrosis, idiopathic pulmonary fibrosis, idiopathic pulmonary hemosiderosis, idiopathic pulmonary hypertension, idiopathic subglottic tracheal stenosis , infant respiratory distress syndrome, infantile apnea, interstitial lung disease, laryngeal cleft, laryngeal edema, laryngomalacia, laryngotracheomalacia, lethal chondrodysplasia Moerman type , lobar emphysema, lung abscess, Matthew-Wood syndrome, meconium aspiration syndrome, Mendelson's syndrome, mountain sickness, obstructive sleep apnea, Pancoast tumor, perinatal asphyxia, Pickwickian syndrome, Pierre Robin syndrome, pleural effusion, pneumoconiosis, pneumonia, pneumothorax, pseudocyanosis, pulmonary alveolar proteinosis, pulmonary arteriovenous fistula, pulmonary arteriovenous malformation, pulmonary artery sling, pulmonary atresia, pulmonary edema, pulmonary embolism, pulmonary fibrosis, pulmonary hemorrhage, pulmonary hypertension, pulmonary hypoplasia, respiratory depression, respiratory distress syndrome, respiratory failure, respiratory muscle paralysis, sarcoidosis, Shaver's disease, sleep apnea, smoke inhalation, spontaneous pneumothorax, sudden infant death syndrome, suffocation, surfactant metabolism dysfunction, tension pneumothorax, tracheal agenesis without tracheoesophageal fistula, tracheal stenosis, tracheoesophageal fistula, transient tachypnea of the newborn, unilateral pulmonary agenesis, unilateral pulmonary hypoplasia, whooping cough
Renal / Electrolyte Cholesterol emboli syndrome, dehydration, Goodpasture syndrome, hypermagnesemia, hypocalcemia, hypomagnesemia
Rheum / Immune / Allergy Angioneurotic edema, Besnier-Boeck-Schaumann disease, Buergers disease, DiGeorge syndrome, extrinsic allergic alveolitis, Goodpasture syndrome, hypersensitivity pneumonitis, insect sting allergy, laryngeal edema, lupus, neonatal myasthenia gravis, Raynaud's disease, Raynaud's phenomenon, sarcoidosis, Shprintzen syndrome, velocardiofacial syndrome
Sexual Weinstein Kliman Scully syndrome
Trauma Flail chest, head trauma, hemothorax, penetrating chest wounds, shaken baby syndrome, thermal injury,
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Choking, drowning, hanging, high altitude, hypothermia, immobility

Causes in Alphabetical Order

Causes of Cyanosis Based on Classification

Causes of Central Cyanosis


Causes of peripheral cyanosis

References

  1. ↑ Olson K, Smollin C (July 2008). "Carbon monoxide poisoning (acute)". BMJ Clin Evid. 2008. PMC 2907971. PMID 19445736.
  2. ↑ Parker-Cote JL, Rizer J, Vakkalanka JP, Rege SV, Holstege CP (February 2018). "Challenges in the diagnosis of acute cyanide poisoning". Clin Toxicol (Phila): 1–9. doi:10.1080/15563650.2018.1435886. PMID 29417853.
  3. ↑ 3.0 3.1 Zoorob RJ, Campbell JS (November 2003). "Acute dyspnea in the office". Am Fam Physician. 68 (9): 1803–10. PMID 14620600.
  4. ↑ 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.
  5. ↑ Barton ED (July 1999). "Tension pneumothorax". Curr Opin Pulm Med. 5 (4): 269–74. PMID 10407699.
  6. ↑ 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.
  7. ↑ Costello RA, Nehring SM. PMID 28722864. Missing or empty |title= (help)
  8. ↑ 8.0 8.1 8.2 Bailliard F, Anderson RH (January 2009). "Tetralogy of Fallot". Orphanet J Rare Dis. 4: 2. doi:10.1186/1750-1172-4-2. PMC 2651859. PMID 19144126.
  9. ↑ Bodson L, Bouferrache K, Vieillard-Baron A (October 2011). "Cardiac tamponade". Curr Opin Crit Care. 17 (5): 416–24. doi:10.1097/MCC.0b013e3283491f27. PMID 21716107.
  10. ↑ Komine S (February 1964). "In vitro studies on the degradation and synthesis of serum proteins in placentae. I. Synthesis of serum proteins". Nippon Juigaku Zasshi. 26 (1): 15–23. PMID 4173631.
  11. ↑ Steinhorn RH (September 2008). "Evaluation and management of the cyanotic neonate". Clin Pediatr Emerg Med. 9 (3): 169–175. doi:10.1016/j.cpem.2008.06.006. PMC 2598396. PMID 19727322.
  12. ↑ 12.0 12.1 Kaur K, Bhardwaj M, Kumar P, Singhal S, Singh T, Hooda S (2016). "Amniotic fluid embolism". J Anaesthesiol Clin Pharmacol. 32 (2): 153–9. doi:10.4103/0970-9185.173356. PMC 4874066. PMID 27275041.
  13. ↑ 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.
  14. ↑ Costumbrado J, Ghassemzadeh S. PMID 29083723. Missing or empty |title= (help)
  15. ↑ Gossman WG, Burns B. PMID 29261942. Missing or empty |title= (help)
  16. ↑ Jain S, Bakshi N, Krishnamurti L (December 2017). "Acute Chest Syndrome in Children with Sickle Cell Disease". Pediatr Allergy Immunol Pulmonol. 30 (4): 191–201. doi:10.1089/ped.2017.0814. PMC 5733742. PMID 29279787.
  17. ↑ Kondamudi NP, Dulebohn SC. PMID 28722923. Missing or empty |title= (help)
  18. ↑ Kondamudi NP, Wilt AS. PMID 28722998. Missing or empty |title= (help)
  19. ↑ Memon J, Manganaro SN. PMID 28722938. Missing or empty |title= (help)
  20. ↑ Bergeron M, Cohen AP, Cotton RT (2017). "The Management of Cyanotic Spells in Children with Oesophageal Atresia". Front Pediatr. 5: 106. doi:10.3389/fped.2017.00106. PMC 5430373. PMID 28555179.
  21. ↑ Maitre B, Similowski T, Derenne JP (September 1995). "Physical examination of the adult patient with respiratory diseases: inspection and palpation". Eur. Respir. J. 8 (9): 1584–93. PMID 8575588.
  22. ↑ Hermansen CL, Mahajan A (December 2015). "Newborn Respiratory Distress". Am Fam Physician. 92 (11): 994–1002. PMID 26760414.
  23. ↑ Bishop NB, Stankiewicz P, Steinhorn RH (July 2011). "Alveolar capillary dysplasia". Am. J. Respir. Crit. Care Med. 184 (2): 172–9. doi:10.1164/rccm.201010-1697CI. PMC 3172887. PMID 21471096.
  24. ↑ Justice NA, Le JK. PMID 28722988. Missing or empty |title= (help)
  25. ↑ Reuter S, Moser C, Baack M (October 2014). "Respiratory distress in the newborn". Pediatr Rev. 35 (10): 417–28, quiz 429. doi:10.1542/pir.35-10-417. PMC 4533247. PMID 25274969.
  26. ↑ Woods WA, McCulloch MA (November 2005). "Cardiovascular emergencies in the pediatric patient". Emerg. Med. Clin. North Am. 23 (4): 1233–49. doi:10.1016/j.emc.2005.07.003. PMID 16199347.
  27. ↑ Driscoll DJ (February 1990). "Evaluation of the cyanotic newborn". Pediatr. Clin. North Am. 37 (1): 1–23. PMID 2407997.
  28. ↑ Martínez de Zabarte Fernández JM, García Íñiguez JP, Domínguez Cajal M (February 2018). "Metahemoglobinemia in infants over one year". Med Clin (Barc). doi:10.1016/j.medcli.2017.12.009. PMID 29439874.
  29. ↑ Günal E, Akkuş Y, Çığşar G, Çiftçi H, Kahramanca Ş, Özdemir M (October 2017). "Methemoglobinemia incidence after the application of lidocaine for small surgical procedures". Agri. 29 (4): 173–176. PMID 29171648.
  30. ↑ Hilbert P, Zur Nieden K (September 2004). "[Suicidal fatal beta-blocker intoxication]". Anaesthesist (in German). 53 (9): 826–9. doi:10.1007/s00101-004-0721-1. PMID 15249969.
  31. ↑ 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.
  32. ↑ Kondamudi NP, Virji M. PMID 28722926. Missing or empty |title= (help)
  33. ↑ Jensen JD, Vincent AL. PMID 28613569. Missing or empty |title= (help)
  34. ↑ Fardoun MM, Nassif J, Issa K, Baydoun E, Eid AH (2016). "Raynaud's Phenomenon: A Brief Review of the Underlying Mechanisms". Front Pharmacol. 7: 438. doi:10.3389/fphar.2016.00438. PMC 5110514. PMID 27899893.
  35. ↑ Das S, Maiti A (November 2013). "Acrocyanosis: an overview". Indian J Dermatol. 58 (6): 417–20. doi:10.4103/0019-5154.119946. PMC 3827510. PMID 24249890.
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