Cyanosis risk factors

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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

Common risk factors in the development of cyanosis include congenital heart diseases with right to left shunting, presence of abnormal hemoglobin, carbon monoxide poisoning, respiratory disorders associated with impaired gas exchange, impaired gas diffusion via the alveoli, embolism, pulmonary arteriovenous malformations, cold exposure, and raynaud's phenomenon.

Risk Factors

The risk factors for cyanosis include:

Any condition that interferes with oxygen from entering the alveoli or interrupts its movement across the alveolar interface leads to hypoxemia and cyanosis.
- Decreased inspired oxygen^[1]^[2]
  - Carbon monoxide exposure
  - Cyanide poisoning
  - Smoke from house fires
- Hypoventilatory disorders:^[3]
  - Upper airway obstruction
    - Foreign body
    - Croup
    - Epiglottitis
    - Bacterial tracheitis
    - Traumatic airway disruption
    - Congenital airway anomalies
  - Neurologic disorders^[4]^[5]^[6]
    - Severe head trauma
    - Transient tachypnea of newborn
    - Seizures
    - BRUE
    - Hypoxic ischemic encephalopathy
    - Intracranial hemorrhage
- Impairment of chest wall or lung expansion^[7]
- V/Q mismatch:
  - Obstructed airways (V):^[8]^[9]
  - Vasculature (Q):^[10]^[11]
    - Acute chest syndrome due to sickle cell disease
    - Pulmonary embolus
    - Vasculitis
  - Parenchymal:^[12]^[13]^[14]
    - ARDS
    - Pneumonia
    - Pulmonary fibrosis
    - Interstitial lung diseases
    - Empyema
- Impaired alveolar-arterial diffusion:^[15]
  - Pulmonary edema
Intracardiac or vascular shunts may cause cyanosis by mixing oxygenated and deoxygenated blood.
- Congenital heart diseases^[16]^[17]^[18]
  - Tetralogy of fallot
  - Tricuspid valve anomalies
  - Transposition of great arteries
  - Pulmonary stenosis
  - Truncus arteriosus
  - Total anomalous pulmonary venous connection
- Structural or vascular alteration in pulmonary blood flow
  - Pulmonary hypertension
  - Multiple intra pulmonary shunts
Cold exposure
Hemoglobinopathies:^[19]^[20]
Raynaud's phenomenon^[21]
Altered mental status
Side effects of pharmacotherapy:^[22]^[23]^[24]
- Beta blockers
- Nitrite or nitrate-containing compounds (eg, nitroglycerin)
- Dapsone
- Sulfonamides
- Benzocaine
- Chloroquine
High altitude^[25]
Disseminated intravascular coagulation^[26]
Venomous snake bites^[27]
Arterial obstruction:
- Peripheral vascular disease
- Buergers disease
Venous obstruction:
Decreased cardiac output:

References

↑ Blumenthal I (June 2001). "Carbon monoxide poisoning". J R Soc Med. 94 (6): 270–2. PMC 1281520. PMID 11387414.
↑ 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.
↑ Zoorob RJ, Campbell JS (November 2003). "Acute dyspnea in the office". Am Fam Physician. 68 (9): 1803–10. PMID 14620600.
↑ Ranjit MS (March 2000). "Cardiac abnormalities in birth asphyxia". Indian J Pediatr. 67 (3 Suppl): S26–9. PMID 11129917.
↑ Kondamudi NP, Dulebohn SC. PMID 28722923. Missing or empty |title= (help)
↑ Kondamudi NP, Virji M. PMID 28722926. Missing or empty |title= (help)
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ Muhe L (1996). "Managing pneumonia". Child Health Dialogue (3–4): 13. PMID 12292168.
↑ Angerio AD, Kot PA (November 1994). "Pathophysiology of pulmonary edema". Crit Care Nurs Q. 17 (3): 21–6. PMID 8000933.
↑ 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.
↑ POTTS WJ (February 1953). "[Congenital heart disease cyanotic children]". Calif Med (in Undetermined). 78 (2): 101–3. PMC 1521678. PMID 13019603.
↑ 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.
↑ Whelan JF (May 1984). "Methemoglobin as a cause of cyanosis". Can Med Assoc J. 130 (10): 1260. PMC 1483499. PMID 6722683.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ Jensen JD, Vincent AL. PMID 28613569. Missing or empty |title= (help)
↑ 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.
↑ 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.
↑ 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.

Template:WH Template:WS

[pmid11387414-1] Blumenthal I (June 2001). "Carbon monoxide poisoning". J R Soc Med. 94 (6): 270–2. PMC 1281520. PMID 11387414.

[pmid21051109-2] 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.

[pmid14620600-3] Zoorob RJ, Campbell JS (November 2003). "Acute dyspnea in the office". Am Fam Physician. 68 (9): 1803–10. PMID 14620600.

[pmid11129917-4] Ranjit MS (March 2000). "Cardiac abnormalities in birth asphyxia". Indian J Pediatr. 67 (3 Suppl): S26–9. PMID 11129917.

[pmid28722923-5] Kondamudi NP, Dulebohn SC. PMID 28722923. Missing or empty |title= (help)

[pmid28722926-6] Kondamudi NP, Virji M. PMID 28722926. Missing or empty |title= (help)

[pmid24734096-7] 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.

[pmid14091905-8] 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.

[pmid22393337-9] 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.

[pmid18272123-10] 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.

[pmid11596167-11] 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.

[pmid19462358-12] 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.

[pmid19868355-13] 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.

[pmid12292168-14] Muhe L (1996). "Managing pneumonia". Child Health Dialogue (3–4): 13. PMID 12292168.

[pmid8000933-15] Angerio AD, Kot PA (November 1994). "Pathophysiology of pulmonary edema". Crit Care Nurs Q. 17 (3): 21–6. PMID 8000933.

[pmid18851735-16] 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.

[pmid13019603-17] POTTS WJ (February 1953). "[Congenital heart disease cyanotic children]". Calif Med (in Undetermined). 78 (2): 101–3. PMC 1521678. PMID 13019603.

[pmid6021453-18] 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.

[pmid6722683-19] Whelan JF (May 1984). "Methemoglobin as a cause of cyanosis". Can Med Assoc J. 130 (10): 1260. PMC 1483499. PMID 6722683.

[pmid28348950-20] 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.

[pmid2375536-21] 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.

[pmid18456031-22] 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.

[pmid6859496-23] 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.

[pmid29465577-24] 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.

[pmid28613569-25] Jensen JD, Vincent AL. PMID 28613569. Missing or empty |title= (help)

[pmid25807263-26] 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.

[pmid25866646-27] 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.

[pmid21276318-28] 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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Cyanosis risk factors

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