CYANOSIS

Ask the following questions:

1. Is there a history of drug ingestion? Potassium chlorate, sulfanilamide, and coal tar products are only a few of the drugs that may cause methemoglobinemia and sulfhemoglobinemia.
2. Is the cyanosis limited to one extremity? If the cyanosis is limited to one extremity, one should suspect an arterial embolism or phlebothrombosis.
3. Is the cyanosis limited to the extremities or is it generalized? Cyanosis that is limited to the extremities only suggests Raynaud's disease, Raynaud's phenomena, shock, and acrocyanosis.
4. Is there associated dyspnea? If there is significant dyspnea, one should consider a pulmonary or cardiac origin for the cyanosis such as cyanotic congenital heart disease, pulmonary emphysema, pulmonary fibrosis, or pulmonary embolism.
5. Is the patient a child or an adult? Certain causes of cyanosis are limited to children, such as laryngismus stridulus, laryngotracheitis, and acute subglottic laryngitis.
6. Is there a heart murmur or cardiomegaly? A heart murmur or cardiomegaly suggests rheumatic carditis, congenital heart disease, or congestive heart failure.

DIAGNOSTIC WORKUP

It is wise to order a cardiology consult at the outset. Arterial blood gases, EKG, chest x-ray, and pulmonary function studies will diagnose most cases that are due to pulmonary or cardiac causes. If there is a history of drug ingestion, the blood should be drawn for methemoglobin and sulfhemoglobin testing. If a pulmonary embolism is suspected, a ventilation-perfusion scan and pulmonary arteriography may need to be done. If a peripheral embolism is suspected, angiography of the vessel involved will be diagnostic. Sputum or nose and throat cultures will be useful in diagnosing the infectious diseases associated with cyanosis.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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