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Cyanosis is the name for poor oxygen circulation in the blood that causes bluish discoloration of the skin. Central cyanosis affects the lips, but it can also affect the tongue and chest.
Blue lips may indicate a type of cyanosis caused by lower levels of oxygen in the red blood cells. Blue lips may also represent high levels of an abnormal form of hemoglobin in the bloodstream (similar to bluish discoloration of the skin).
If normal color returns with warming or massage, your lips aren’t getting enough blood supply. They might not be due to cold, constriction, or some other reason. If the lips remain blue, then there may be an underlying disease or structural abnormality. Either of these can interfere with the body’s ability to deliver oxygenated red blood to the body.
The most common causes of blue lips are events that limit the amount of oxygen that the lungs take in, including:
Lung disease and congenital (present at birth) heart abnormalities can also cause cyanosis and the appearance of blue lips.
Less common causes of blue lips include polycythemia vera (a bone marrow disorder that causes the production of excess red blood cells) and cor pulmonale (a decrease in the function of the right side of the heart, caused by long-term high blood pressure). Septicemia, or blood poisoning caused by bacteria, may also lead to blue lips.
In addition, blue lips may be associated with the following conditions:
Cold weather conditions, vigorous exercise, and becoming "winded" from physical exertion can sometimes cause a temporary blue appearance in the lips.
A noninvasive pulse oximeter is the simplest way to measure the oxygenation of the blood. Arterial blood gases (ABGs) are drawn to measure oxygenation and determine other factors that may be contributing to blue lips. A pulse oximeter is able to determine the concentration of oxygen in your blood by comparing how much "red light" and "infrared light" is being absorbed by your blood.
There are times when a pulse oximeter will not be necessary to find out what is causing your blue lips. If you have already been diagnosed with asthma, emphysema, or another breathing issue, your doctor will probably conclude right away that your blue lips are being caused by that condition.
Treatment of blue lips involves identifying and correcting the underlying cause and restoring the flow of oxygenated blood to the lips. Once you have been diagnosed appropriately, one of several things may happen.
If you are on blood pressure medication, beta blockers, or blood thinners, the dosage may need to be adjusted. This is to ensure that your white blood cell count and red blood cell count remain balanced.
If you have a respiratory diagnosis such as emphysema or COPD, it is possible that blue lips are an indication that your condition has worsened. In that case, your doctor may recommend lifestyle changes such as quitting smoking and starting an exercise regimen that will improve your respiratory and vascular health. Pulmonary rehabilitation may be recommended.
Cyanosis that is only found in the areas around the lips, hands, and feet is called "acrocyanosis." It is not a cause for concern in children under the age of 2. However, if the tongue, head, torso, or lips themselves appear bluish, then the child needs to be examined by a doctor.
Blue lips in children under 2 years old can be a symptom of an RSV (respiratory syncytial virus) infection. Though an RSV infection is common and most kids have the virus at some point before their 2nd birthday, don’t assume that it’s what is causing the lip discoloration. If your child’s lips are discolored, make sure that a pediatrician examines them.
In some cases, blue lips can signal a serious blood and respiratory condition. In other cases, blue lips indicate chemical poisoning as a result of ingesting antifreeze or ammonia. It’s essential that your child receive the correct diagnosis before they begin any sort of treatment.
Call an emergency hotline immediately if blue lips are accompanied by any of the following symptoms:
If your blue lips occur suddenly and are not the result of strenuous exercise or time spent outdoors, call for emergency assistance. If your cyanosis comes on gradually, keep an eye on it and schedule an appointment with your general practitioner if it does not subside after a day or two.
If there is an underlying condition causing your lips to appear blue, the discoloration will go away once the cause is identified and addressed. The amount of time it will take for the blue lips to subside varies widely, depending on what is causing it.
Lip discoloration does not always indicate an emergency situation, but it’s not a symptom that should be ignored.
Written by: JC Jones MA, RN and Kathryn Watson
Medically reviewed on: Dec 15, 2016: Debra Sullivan, PhD, MSN, CNE, COI
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