Cyanosis causes
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]
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.
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)
- 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 (Thermal injury, 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
- 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:
- Intrinsic lung diseases:
- 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
- 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
- Miscellaneous:
- Acute chest syndrome
- Brief resolved unexplained events (BRUE)
- High altittude
- Drowning
- Chocking
- Hanging
- Hypothermia
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
- Cardiac tamponade
- Cyanide poisoning
- Disseminated intravascular coagulation
- Epiglottitis
- Ethylene glycol
- Foreign body aspiration
- Hemothorax
- Malathion
- Myocardial infarction
- Parathion
- Pulmonary embolism
- Tension pneumothorax
Common Causes
- Birth asphyxia
- High altitude
- Methemoglobinemia
- Pulmonary stenosis
- Respiratory distress syndrome
- Tetralogy of Fallot
- Transposition of the great arteries
- Tricuspid atresia
Causes by Organ System
Causes in Alphabetical Order
Causes of Cyanosis Based on Classification
Causes of Central Cyanosis
Causes of Peripheral Cyanosis
- Acrocyanosis
- Asthma
- Beta blockers
- Buergers disease
- Chronic obstructive pulmonary disease
- Cold exposure
- Congenital heart disease
- Deep vein thrombosis
- Emphysema
- Erythrocyanosis
- Heart failure
- High altitude
- Hypothermia
- Hypovolemia
- Methemoglobinemia
- Peripheral arterial disease
- Polycythemia vera
- Pulmonary embolism
- Raynaud's disease
- Raynaud's disease
- Raynaud's phenomenon
- Sepsis
- Shock
- Tetralogy of Fallot
References
- ↑ DiMaio AM, Singh J (October 1992). "The infant with cyanosis in the emergency room". Pediatr. Clin. North Am. 39 (5): 987–1006. PMID 1523025.
- ↑ Driscoll DJ (February 1990). "Evaluation of the cyanotic newborn". Pediatr. Clin. North Am. 37 (1): 1–23. PMID 2407997.
- ↑ Frank DB, Hanna BD (April 2015). "Pulmonary arterial hypertension associated with congenital heart disease and Eisenmenger syndrome: current practice in pediatrics". Minerva Pediatr. 67 (2): 169–85. PMC 4382100. PMID 25604592.
- ↑ Izraelit A, Ten V, Krishnamurthy G, Ratner V (2011). "Neonatal cyanosis: diagnostic and management challenges". ISRN Pediatr. 2011: 175931. doi:10.5402/2011/175931. PMC 3317242. PMID 22482063.
- ↑ Serino G, Giacomazzi F (2010). "[Pulmonary arterial hypertension in adult patients with congenital heart disease]". Pediatr Med Chir (in Italian). 32 (6): 274–9. PMID 21462449.
- ↑ Curry S (April 1982). "Methemoglobinemia". Ann Emerg Med. 11 (4): 214–21. PMID 7073040.
- ↑ Ash-Bernal R, Wise R, Wright SM (September 2004). "Acquired methemoglobinemia: a retrospective series of 138 cases at 2 teaching hospitals". Medicine (Baltimore). 83 (5): 265–73. PMID 15342970.
- ↑ Kondamudi NP, Dulebohn SC. PMID 28722923. Missing or empty
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