Sandbox:Chandra: Difference between revisions
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====Central Cyanosis:==== | ====Central Cyanosis:==== | ||
There following are some of the | There following are some of the common causes of central cyanosis:<ref name="pmid1523025">{{cite journal |vauthors=DiMaio AM, Singh J |title=The infant with cyanosis in the emergency room |journal=Pediatr. Clin. North Am. |volume=39 |issue=5 |pages=987–1006 |date=October 1992 |pmid=1523025 |doi= |url= |author=}}</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= |author=}}</ref> <ref name="pmid25604592">{{cite journal |vauthors=Frank DB, Hanna BD |title=Pulmonary arterial hypertension associated with congenital heart disease and Eisenmenger syndrome: current practice in pediatrics |journal=Minerva Pediatr. |volume=67 |issue=2 |pages=169–85 |date=April 2015 |pmid=25604592 |pmc=4382100 |doi= |url= |author=}}</ref> <ref name="pmid22482063">{{cite journal |vauthors=Izraelit A, Ten V, Krishnamurthy G, Ratner V |title=Neonatal cyanosis: diagnostic and management challenges |journal=ISRN Pediatr |volume=2011 |issue= |pages=175931 |date= 2011 |pmid=22482063 |pmc=3317242 |doi=10.5402/2011/175931 |url= |author=}}</ref> <ref name="pmid21462449">{{cite journal |vauthors=Serino G, Giacomazzi F |title=[Pulmonary arterial hypertension in adult patients with congenital heart disease] |language=Italian |journal=Pediatr Med Chir |volume=32 |issue=6 |pages=274–9 |date= 2010 |pmid=21462449 |doi= |url= |author=}}</ref> <ref name="pmid7073040">{{cite journal |vauthors=Curry S |title=Methemoglobinemia |journal=Ann Emerg Med |volume=11 |issue=4 |pages=214–21 |date=April 1982 |pmid=7073040 |doi= |url= |author=}}</ref> <ref name="pmid15342970">{{cite journal |vauthors=Ash-Bernal R, Wise R, Wright SM |title=Acquired methemoglobinemia: a retrospective series of 138 cases at 2 teaching hospitals |journal=Medicine (Baltimore) |volume=83 |issue=5 |pages=265–73 |date=September 2004 |pmid=15342970 |doi= |url= |author=}}</ref> <ref name="pmid28722923">{{cite journal |vauthors=Kondamudi NP, Dulebohn SC |title= |journal= |volume= |issue= |pages= |date= |pmid=28722923 |doi= |url= |author=}}</ref> | ||
*'''Conditions associated with decreased concentration of inspired oxygen (FiO2):''' | *'''Conditions associated with decreased concentration of inspired oxygen (FiO2):''' | ||
**[[Smoke inhalation]] most commonly from house fires | **[[Smoke inhalation]] most commonly from house fires | ||
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*Brief resolved unexplained events (BRUE) | *Brief resolved unexplained events (BRUE) | ||
====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 cause peripheral cyanosis. |
Revision as of 21:12, 21 February 2018
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]
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:
There following are some of the common causes of central cyanosis:[1] [2] [3] [4] [5] [6] [7] [8]
- Conditions associated with decreased concentration of inspired oxygen (FiO2):
- Smoke inhalation most commonly from house fires
- Carbon monoxide poisoning
- Hydrogen cyanide poisoning
- Intentional or unintensional exposure to asphyxiating gases (eg, Propane, methane, butane, hydrogen sulphide)
- Decresed atmospheric pressure: High altitude
- Disorders associated with impairment of chest wall or lung expansion:
- External compression
- Pneumothorax
- Hemothorax
- Flail chest
- Hypoventilation:
- Upper airway obstruction:
- Foreign body aspiration
- Pertussis / Croup
- Epiglottitis
- Tracheitis mostly bacterial
- Traumatic disruption (burns, fractures)
- Congenital airway abnormalities:
- Choanal atresia
- Laryngotracheomalacia
- Macroglossia
- Micrognathia or retrognathia (eg, Pierre-Robin syndrome)
- Neurologic abnormalities:
- CNS depression
- Severe head trauma
- Apnea of prematurity
- Infections (eg, meningitis, encephalitis)
- Intraventricular hemorrhage
- 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:
- Severe hypoglycemia
- In born errors of metabolism
- Upper airway obstruction:
- Ventilation/perfusion mismatch:
- Asthma
- Pulmonary embolism
- Atelectasis
- Alveolar capillary dysplasia
- emphysema or COPD
- Pulmonary edema
- Pulmonary hypoplasia
- Pulmonary hemorrhage
- Respiratory distress syndrome (Hyaline membrane disease)
- Transient tachypnea of the newborn
- Conditions causing impaired oxygen diffusion:
- Pneumonia
- Bronchiolitis
- Bronchopulmonary dysplasia
- Cystic fibrosis
- Empyema
- Vascular causes:
- Cyanotic congenital heart diseases (Right to left shunts):
- Decreased pulmonary flow:
- Tetralogy of fallot
- Tricuspid valve anomalies:
- Pulmonary stenosis (critical valvular)
- Pulmonary atresia with intact ventricular septum
- Increased pulmonary flow:
- TGA (Transposition of great arteries, most common dextro type)
- Truncus arteriosus
- TAPVC (Total anamalous pulmonary venous connection)
- Heart failure: Condition that present with cyanosis and severe heart failure include:
- Left sided obstructive lesion (HLHS)
- Coarctation of aorta
- Critical valvular aortic stenosis
- Decreased pulmonary flow:
- Eisenmenger syndrome
- Pulmonary causes:
- Pulmonary hypertension
- Pulmonary edema
- Pulmonary hemorrhage
- Pulmonary embolism
- Pulmonary arterio venous malformations
- Multiple small intrapulmonary shunts
- Shock
- Sepsis
- Acute chest syndrome
- Cyanotic congenital heart diseases (Right to left shunts):
- Hematologic abnormalities:
- Methemoglobinemia (congenital or acquired)
- Sulfhemoglobinemia (acquired)
- Hemoglobin mutations with low oxygen affinity: Hb Kansas, Hb Beth israel, Hb Saint Mande, Hb Bruxells
- Polycythemia
- Brief resolved unexplained events (BRUE)
Peripheral Cyanosis:
There following are some of the Common causes of Peripheral Cyanosis: [9] [10]
- Various conditions that cause central cyanosis can also cause peripheral cyanosis.
- Cold exposure
- Decreased cardiac output (Left sided heart failure, shock or hypovolemia)
- Acrocyanosis
- Raynaud's phenomenon
- Arterial obstruction (Peripheral vascular disease)
- Venous obstruction (Thromboembolism)
- Redistribution of blood flow from extremities
Life Threatening Causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
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