Cyanosis : Causes, Symptoms, Diagnosis, Treatment, Cures and Remedies for Cyanosis, Methemoglobinemia, Sulfhemoglobinemia, and Pseudocyanosis.
Why Does the Skin Pigment and Finger Nails Turn Blue?
When the unoxygenated hemoglobin (also known as reduced hemoglobin) levels in the capillaries exceed 5 g/dL, the skin pigment, the mucousal membranes the finger nail beds, and in some cases, even feet, ears, and nose turn blue.
It must be noted, however, that the bluish skin pigment tinge in itself is not the disease, it is often the most visible sign of low blood oxygen saturation levels -Cyanosis.
In many cases, cyanosis is quite obvious when blood oxygen satuation levels fall below 90%. It is also important to note that many anemic patients do not show any visible signs of cyanosis even when they are hypoxemic.
What Causes Cyanosis?
Cyanosis (a condition of very low oxygen saturation with normal hemoglobin) may be caused by many reasons, including: abnormal hemoglobin levels, asthma, atelectasis, benzodiazepines drug overdoses, breath holding, bronchiolitis, cardiopulmonary arrest, chronic obstructive pulmonary disease (COPD), congenital heart disease, congestive heart failure, croup, cyanide poisoning, cyanotic heart disease, drowning, epiglottitis, exposure to cold, foreign body aspiration, high altitudes, lack of fresh air, low oxygen levels in the air, methemoglobinemia, narcotics drug overdoses, pneumonia, pulmonary edema, pulmonary hypertension, respiratory failure, sedatives drug overdoses, seizures, shock, and suffocation. It is also caused by:
- Methemoglobinemia results from abnormally high Methemoglobin (HbFe+2) levels. Considering that metHb is unable to bind with oxygen, as the HbFe+2 levels go up, arterial oxygen saturation goes down correspondingly, often resulting in Cyanosis.
- Sulfhemoglobinemia deonted a rare condition caused by sulfur binding with hemoglobin. Just like Methemoglobin, Sulfhemoglobin too is unable to bind with oxygen. As the Sulfhemoglobin levels increase, it lowers the blood oxygen saturation levels (SaO2), the typical bluish tinge, often leading to Cyanosis.
- Pseudocyanosis is a bluish tinge of the skin and/or mucousal membranes that is not caused by hypoxemia, peripheral vasoconstriction (such as Raynaud's Syndrome caused by spasm of blood vessels in the hands, often following exposure to extreme cold temperatures), or a collagen-vascular disease such as scleroderma. Most Pseudocyanosis cases can be traced back to a recent contact with lead, silver compounds (such as silver iodide, silver, silver nitrate), drugs such as amiodarone, chloroquine hydrochloride, and/or phenothiazines.
Diagnosis of Cyanosis:
Years ago during the time when the technologies that have made rapid blood gas analysis a reality were unheard of, cyanosis was diagnosed almost entirely on clinical assessments -albeit with an alarmingly high degree of unreliability. Considering that a clinician's perception of skin color largely depends on his/her subjective analysis, as well as the fact the appearance of natural skin pigment is often greatly influenced by the room lighting conditions, detection of cyanosis on the basis of clinical observations alone often results in false positives (patients erronously diagnosed to have cyanosis even though their blood oxygen levels are normal) as well as false negative (failure to diagnose cyanosis in spite of low blood oxygen saturation levels) diagnosis of cyanosis. Mild cyanosis is often difficult to detect. Pulse oximetry, Arterial blood gas measurement (PaO2, SaO2 levels), Complete blood count (CBC), chest X-ray, ECG along a careful review of patients history and clinical signs usually provide more reliable diagnosis of Cyanosis.
Treatment for Cyanosis largely depends upon the underlying cause. For example, for cyanosis caused by exposure to cold, moving to a well-heated, warm environment, and putting on warm clothes is often quite effective in resolving cyanosis. Supplemental oxygen is often administered to help increase blood oxygen saturation levels.
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