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Cyanosis of the nail bed
Cyanosis of the nail bed

Skin discoloration - bluish
Definition:
Bluish discoloration of the skin or mucous membranes caused by lack of oxygen in the blood. See also skin color, patchy.

Alternative 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 blood flowing through it. Blood that is saturated with oxygen is bright red. Blood that has lost its oxygen is dark bluish-red. People who have a large quantity 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 occurs as a result of heart disease such as congestive heart failure, pulmonary disease, or as a terminal event as in cardiopulmonary arrest.

Mild cyanosis is difficult to detect. Their needs to be more than 5 grams of deoxygenated hemoglobin in a person's bloodstream to see cyanosis. Usually the oxygen saturation of the blood has to drop below 90% before this occurs.

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.

Many people get brief bluish-purplish painful color changes in their fingers -- this is called Raynaud's Syndrome which results from spasm of blood vessels in the hands, often in response to the cold. Some people with Raynaud's Syndrome also have a collagen-vascular disease called scleroderma.
Common Causes:
Home Care:
For cyanosis caused by exposure to cold, dress warmly when going outside or stay in a well-heated room.
Call your health care provider if:
  • there is any unexplained cyanosis.
What to expect at your health care provider's office:
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
The physical examination will include listening to the breath sounds and heart (auscultation).

Diagnostic tests that may be performed include: For shortness of breath and cyanosis, supplemental oxygen may be administered.
Review Date: 12/6/2001
Reviewed By: Darrell N. Kotton, M.D., Division of Pulmonary and Critical Care, Boston University School of Medicine, Boston, MA. Review provided by VeriMed Healthcare Network.
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