Emergency — phone the vet nowImmediately — minutes matter. Blue gums indicate life-threatening oxygen deprivation. This is one of the most serious signs in veterinary medicine.

Dog with blue or grey gums

Call your emergency vet NOW and start driving — blue or grey gums mean your dog's body is not getting enough oxygen. Do not wait.

Dog

In the next 60 seconds

1. CALL YOUR EMERGENCY VET NOW — phone while acting. Do not delay to look up information.
2. Check the airway: if you can see a foreign body blocking the throat and your dog is conscious, attempt to remove it with your fingers — but do not perform blind finger sweeps that could push the object deeper.
3. If the dog is choking and unconscious: lay the dog on its side, open the mouth, look for the obstruction, and try to remove it. Give 5 firm blows to the back of the chest between the shoulder blades if the obstruction cannot be removed by hand.
4. Modified Heimlich manoeuvre for an unconscious choking dog: place both hands below the sternum and give 5 firm inward-upward thrusts. This is a last resort.
5. If the dog is breathing (even with difficulty) and gums are blue, do not delay to attempt interventions at home — get in the car and drive to the emergency vet immediately.
6. Keep the dog as calm and still as possible — exertion and excitement worsen oxygen demand.
7. Do not muzzle a dog with breathing difficulty — they need an open airway.
8. Keep the car window open slightly for fresh air.
9. If paracetamol or toxin ingestion is known or suspected, tell the vet immediately on arrival or by phone — methaemoglobinaemia requires specific antidote treatment.

Recognise the signs

Gum colour: blue, grey, purple, or lavender — check by gently lifting the lip and looking at the gum tissue above the teeth
Normal gum colour is salmon pink, moist, and has a capillary refill time (CRT) of less than 2 seconds
Laboured, rapid, or very shallow breathing
Flared nostrils with every breath
Open-mouth breathing in a dog (unusual and alarming)
Extended neck reaching forward, elbows out — classic distress posture to maximise airway
Extreme restlessness or conversely sudden collapse
Tongue appearing blue or purple
Weakness, collapse, or loss of consciousness
In partial obstruction: high-pitched wheezing (stridor) on inhalation or exhalation
Panicked, wide-eyed expression

First aid steps

1. CALL YOUR EMERGENCY VET NOW — phone while acting. Do not delay to look up information.
2. Check the airway: if you can see a foreign body blocking the throat and your dog is conscious, attempt to remove it with your fingers — but do not perform blind finger sweeps that could push the object deeper.
3. If the dog is choking and unconscious: lay the dog on its side, open the mouth, look for the obstruction, and try to remove it. Give 5 firm blows to the back of the chest between the shoulder blades if the obstruction cannot be removed by hand.
4. Modified Heimlich manoeuvre for an unconscious choking dog: place both hands below the sternum and give 5 firm inward-upward thrusts. This is a last resort.
5. If the dog is breathing (even with difficulty) and gums are blue, do not delay to attempt interventions at home — get in the car and drive to the emergency vet immediately.
6. Keep the dog as calm and still as possible — exertion and excitement worsen oxygen demand.
7. Do not muzzle a dog with breathing difficulty — they need an open airway.
8. Keep the car window open slightly for fresh air.
9. If paracetamol or toxin ingestion is known or suspected, tell the vet immediately on arrival or by phone — methaemoglobinaemia requires specific antidote treatment.

Do NOT

Do NOT wait to see if the gums return to pink on their own — they will not without intervention.
Do NOT muzzle the dog.
Do NOT lay a dog with breathing difficulty forcibly on its side (unless unconscious and performing CPR).
Do NOT give food, water, or medications.
Do NOT leave the dog alone.
Do NOT search the internet instead of calling the vet.
Do NOT attempt CPR unless the dog has no pulse and is not breathing — CPR is for cardiac arrest only.

While transporting to the vet

Have someone drive while you monitor and comfort the dog — do not transport alone if avoidable.
Keep the dog as still and calm as possible — oxygen demand increases with movement.
Do not lay the dog flat on its side unless unconscious — many dogs with respiratory distress breathe better propped on their sternum or in a sitting position.
Do not muzzle.
Phone ahead so the vet team is ready with oxygen at the door.
Keep windows cracked for air flow without cold draught.

When to phone the vet immediately

Gum colour is blue, grey, or purple — this IS the escalation trigger. Go now.
Dog loses consciousness
Dog stops breathing — begin CPR (30 chest compressions to 2 rescue breaths if trained)
Gums are improving but breathing is still laboured — continue to vet urgently

When it can usually wait

There are no circumstances in which blue or grey gums can wait. This is always an emergency.

Common causes

Airway obstruction — choking on a foreign body (ball, bone, toy, food)
Severe respiratory disease — pneumonia, pleural effusion (fluid around lungs), pulmonary oedema (fluid in lungs)
Acute heart failure — sudden inability of the heart to pump adequately
Anaemia — severe enough to prevent adequate oxygen delivery (bleeding, immune-mediated haemolytic anaemia)
Shock — distributive, hypovolaemic, or cardiogenic shock
Tension pneumothorax (air in the chest cavity compressing the lungs)
Methaemoglobinaemia — paracetamol (acetaminophen) toxicity, certain other toxins oxidising haemoglobin so it cannot carry oxygen
Severe laryngeal paralysis causing upper airway obstruction (common in older Labradors)
Brachycephalic obstructive airway syndrome (BOAS) in severe crisis

What the vet will need to know

What colour are the gums right now?
When did you first notice the colour change?
Is the dog breathing? How is the breathing — rate, effort, character?
Any known toxin or medication exposure (especially paracetamol)?
Any possibility of choking — was the dog eating, playing, or chewing something?
Any known heart or lung disease?
Has the dog collapsed, lost consciousness, or had seizures?
Any visible bleeding or signs of trauma?
Dog's age, weight, and breed

Aftercare

Follow all veterinary instructions carefully after discharge — the underlying cause determines aftercare.
Oxygen therapy at home may be needed for some respiratory conditions.
Administer all medications as prescribed — diuretics, heart medications, antibiotics, steroids as appropriate.
Restrict exercise according to vet guidance while the dog recovers.
Monitor gum colour at home daily as instructed and return if any return to abnormal colour.
Attend all follow-up appointments.
Learn basic pet first aid — including how to assess gum colour — so you can detect emergencies early in the future.

Prevention

Do not allow dogs access to foreign bodies that could cause choking — certain balls, toys, bones, and food items.
Keep paracetamol, ibuprofen, and all human medications locked away and out of reach.
Attend annual heart checks — early detection of heart disease allows medication before crisis.
BOAS surgery in severely affected brachycephalic dogs can prevent respiratory crises.
Ensure your dog is vaccinated against conditions that can cause severe pneumonia.
Learn to check gum colour at home — make it part of routine checks.

Breed-specific notes

French Bulldogs, Pugs, Bulldogs, Shih Tzu, Pekingese (brachycephalic breeds): narrowed airways mean any further obstruction or respiratory illness causes crisis rapidly. Know your local emergency vet.
Cavalier King Charles Spaniels: very high prevalence of mitral valve disease progressing to heart failure — cyanosis is a late sign of decompensation.
Boxers and Dobermanns: dilated cardiomyopathy — sudden heart failure possible.
Labrador Retrievers (older, over 9): laryngeal paralysis is common and can cause sudden respiratory crisis.

Frequently asked questions

How do I check my dog's gum colour?

Gently lift your dog's upper lip and look at the gum tissue above the front teeth, or the inner surface of the lower lip. Normal gums are moist, pink (salmon-coloured), and when you press firmly with a fingertip for 2 seconds and release, the white mark should return to pink within 2 seconds (capillary refill time). Pale, white, grey, blue, purple, or bright red gums are all abnormal. Practise this check on your healthy dog so you know their normal colour.

What does methaemoglobinaemia mean and what causes it in dogs?

Methaemoglobinaemia occurs when haemoglobin (the oxygen-carrying molecule in red blood cells) is chemically converted to methaemoglobin, which cannot carry oxygen. This turns the blood brown rather than red, causing gums to appear blue-grey or muddy brown. In dogs, the main cause in the UK is paracetamol (acetaminophen) toxicity — dogs lack the enzyme to safely metabolise paracetamol. Certain other chemicals and some topical anaesthetics can also cause it. Treatment requires a specific antidote — acetylcysteine — given by the vet.

Should I perform the Heimlich manoeuvre on my dog if it's choking?

A modified Heimlich manoeuvre can be performed as a last resort when a dog is choking and unconscious and you cannot remove the obstruction by hand. For small dogs, hold them with their back against your chest and give upward abdominal thrusts below the ribcage. For large dogs, stand behind them and give upward abdominal thrusts. However, if the dog is conscious and breathing at all, get to the emergency vet rather than performing this procedure at home — it can cause injury if done incorrectly.

My dog's gums look a bit bluish — could it be the light?

Lighting can be deceptive — check gum colour in good natural light or under a clear white light. If you are uncertain, compare to the inner lip colour and look at the tongue. If there is any doubt, check capillary refill time — press firmly for 2 seconds, the colour should return in under 2 seconds. If you are still unsure, call your vet immediately and describe what you see. It is always better to call and be reassured than to wait with genuinely blue gums.

My dog has known heart disease — what signs should make me go to the emergency vet?

Blue or grey gums, severe breathing difficulty at rest (not just on exercise), coughing up pink frothy fluid, collapse, or a sudden dramatic increase in breathing rate or effort are all emergency signs in a dog with known heart disease. Learn your dog's resting respiratory rate at home — count breaths per minute while sleeping. A resting respiratory rate consistently above 30 breaths per minute is an early warning sign of developing heart failure and warrants urgent veterinary contact.