# Cyanosis

- Category: chronic
- Review status: reviewed (every claim checked against a document named on this page)
- Sources: Cyanosis - StatPearls (NCBI Bookshelf NBK559167) - https://www.ncbi.nlm.nih.gov/books/NBK559167/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class SS07.00 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care
- Verified date: 2026-08

## Verified against

- No dose - referral pathway, no medicine given in primary care

## Treatment metadata

- No drug therapy in primary care (Referral & Advice)

## Complete treatment card

```text
CYANOSIS
Sources: Cyanosis - StatPearls (NCBI Bookshelf NBK559167) -
         https://www.ncbi.nlm.nih.gov/books/NBK559167/ · ICPC-3 (WONCA International Classification
         of Primary Care, 3rd edition) class SS07.00 - condition scope only, no dose · No dose -
         referral pathway, no medicine given in primary care
Review status: REVIEWED against the source listed above  (2026-08)

IS IT THIS? - reference only, to read alongside your own examination
  SYMPTOMS - what the patient reports (4)
    - Cyanosis present since birth suggests a congenital cause; recent onset suggests an acquired
      one  [cyanosis]
    - Cyanosis in the first week of life suggests tricuspid atresia, Ebstein anomaly, or critical
      pulmonary stenosis  [cyanosis · stricture]
    - Cyanosis appearing after the first week suggests tetralogy of Fallot, transposition of the
      great arteries, or truncus arteriosus  [cyanosis]
    - Fever with cyanosis points to an infectious cause such as croup, pneumonia, or septic shock
      [cyanosis · fever · shock]
  SIGNS - what you find (5)
    - Capillary refill over 2 seconds is typical of peripheral cyanosis  [cold peripheries ·
      cyanosis]
    - Peripheral cyanosis resolves with massage and warming  [cyanosis]
    - Central cyanosis is best seen on the lips, tongue, and mucous membranes  [cyanosis]
    - Digital clubbing can develop with long-standing central cyanosis  [cyanosis · finger clubbing]
    - The thin skin over the cheeks, nose, ears, and oral mucosa makes them the best places to check
      for cyanosis  [cyanosis]
  TESTS (5)
    - Pulse oximetry is the first noninvasive test used to rule out life-threatening hypoxemia
    - Pulse oximetry can falsely read low in peripheral cyanosis or dyshemoglobinemia
    - Arterial blood gas is normal (85 to 100 percent) in peripheral cyanosis but low in central
      cyanosis
    - Co-oximetry can identify abnormal hemoglobin forms such as methemoglobin or carboxyhemoglobin
    - Pseudocyanosis shows normal readings on both pulse oximetry and co-oximetry
  IF NOT THIS - what else fits (4)
    - Methemoglobinemia or sulfhemoglobinemia should be suspected when central cyanosis fails to
      improve with oxygen
    - Reversed differential cyanosis, more marked in the upper limbs, occurs with transposition of
      the great arteries
    - Drugs such as amiodarone or silver can cause gray-blue skin discoloration mimicking cyanosis
    - Pigmentary birthmarks or large tattoos can mimic cyanosis
  Source  StatPearls "Cyanosis" - disease-level clinical article
  Status  traced to the source above

1. NO DRUG THERAPY IN PRIMARY CARE (REFERRAL & ADVICE)    [1st line]
   Adult    A clinical sign of low blood oxygen or poor perfusion; the primary care role is urgent
            recognition, oxygen if available, and immediate referral or emergency transfer rather
            than routine prescribing. - Refer, with advice
   Peds     Children follow the same pathway: recognise and refer. No primary-care medicine is
            implied.
   Source   No dose - referral pathway, no medicine given in primary care
   Why      A clinical sign of low blood oxygen or poor perfusion; the primary care role is urgent
            recognition, oxygen if available, and immediate referral or emergency transfer rather
            than routine prescribing.
   Caution  Central cyanosis with breathing difficulty or altered consciousness is a medical
            emergency requiring immediate transfer.
            No medicine is prescribed for this in primary care - this entry is for recognition and
            referral. Anything given is decided by the service it is referred to.

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.
```

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