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Toxicity Nomographs: GIF versions of the Rumack-Matthew and Done nomograms for Acute Acetaminophen and Salicylate Toxicity

April 5, 2008

We've been working on a dynamic toxicity nomogram-generation routine for both the Rumack-Matthew nomogram for acute acetaminophen toxicity, and the Done nomogram for acute salicylate toxicity, both of which are now on-line.

The general concept: it would be nice if we could create such graphs in real-time, without having to go to a third-party application to create it for us, or having to go to a reference text to roughly plot it.

As such, we've created GIF versions of these nomograms, using both US and SI units. Feel free to use/adapt these to enhance your own medical web sites, databases, utilities, information systems, etc.

Please realize, and advise other users of these nomograms, that these nomograms are only for the acute overdose. Chronic ingestion can result in severe toxicity or even lethality with much lower serum levels.

Even in the acute overdose, toxicity suggested by plotted values is always approximate. Individual clinical responses can vary greatly, and a lethal overdose in one person might be mild or moderate in another. Conversely, a patient may be sicker than the numbers suggest. The Done nomogram in particular is less accurate than desired.

As always, let your actions be guided, not by the value, but by the patient.
 

Rumack-Matthew Nomogram for Acetaminophen Toxicity

S.I. values: µmol/L

Rumack-Matthew Nomogram for Acetaminophen Toxicity: estimated hepatotoxicity in the acute overdose. SI version: µmol/L

Adapted from Rumack BH, Matthew H. Acetaminophen poisoning and toxicity. Pediatrics 1975;55(6):871876.
 

U.S. values: µg/mL

Rumack-Matthew Nomogram for Acetaminophen Toxicity: estimated hepatotoxicity in the acute overdose. US version: µg/mL

Adapted from Rumack BH, Matthew H. Acetaminophen poisoning and toxicity. Pediatrics 1975;55(6):871876.
 

Done Nomogram for Salicylate Toxicity

S.I. values: mmol/L

Done Nomogram for Salicylate Toxicity: estimated toxicity in the acute overdose. SI version: &mmol/L

Adapted from Done AK. Salicylate intoxication: significance of measurements of salicylate in blood in cases of acute ingestion. Pediatrics 1960;26:800-7.
 

U.S. values: mg/dL

Done Nomogram for Salicylate Toxicity: estimated toxicity in the acute overdose. US version

Adapted from Done AK. Salicylate intoxication: significance of measurements of salicylate in blood in cases of acute ingestion. Pediatrics 1960;26:800-7.
 

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