Alternate Names: Lips - bluish; Fingernails - bluish; Cyanosis; Bluish lips and fingernails; Bluish skin

Considerations: Skin coloration is determined by the amount of pigment in the skin and the red blood flowing beneath it. Blood that is saturated with oxygen is bright red. Blood that has lost its oxygen is dark bluish-red. People who have a high percentage of their blood which is deficient in oxygen tend to take on a bluish discoloration called cyanosis.

Lack of oxygen (such as in suffocation or cyanotic heart disease), abnormal hemoglobin (such as methemoglobinemia) and toxins (such as cyanide) can all produce cyanosis. Most cyanosis is seen as a result of congenital heart disease, pulmonary disease, or as a terminal event as in cardiopulmonary arrest.

Mild cyanosis is difficult to detect. Usually the oxygen saturation of the blood has to drop below 80% before it can be detected.

Cyanosis is more obvious in the mucous membranes and nail beds, particularly for dark-skinned people. It can also appear on the feet, nose, and ears.

Common Causes:

• brief exposure to cold air or water
• high altitudes
• chronic obstructive pulmonary disease (COPD)
• pneumonia, severe
• pulmonary edema
• shock
• hyaline membrane disease associated with prematurity
• aspiration with suffocation
• breath holding
• bronchiolitis
• congenital heart disease
• croup
• epiglottitis
• asthma
• seizures
• drug overdoses (narcotics, benzodiazepines, sedatives)

Home Care: For cyanosis caused by exposure to cold, dress warmly when going outside or stay in a well-heated room.

Call If:

• there is any unexplained, severe, or prolonged cyanosis.

What To Expect: The medical history will be obtained and a physical examination performed. In emergency situations (such as shock), the patient will be stabilized first.

Medical history questions documenting cyanosis in detail may include:

• time pattern
  • When did it develop?
  • Did it develop suddenly?
  • Has it been developing slowly?
• quality
  • Are the lips blue?
  • Are the nailbeds blue?
  • Is the body blue all over?
• aggravating factors
  • Have you had an exposure to cold?
  • Have you suddenly gone to a high altitude?
  • Have you inhaled anything?
• other
  • What other symptoms are also present?
  • Is there difficulty breathing?
  • Is there ankle, feet, and leg swelling?
  • Is there a cough?

• arterial blood gas analysis
• complete blood count (CBC)
• chest X-ray
• ECG