Done Nomogram (Salicylate Toxicity)
Estimates severity of acute salicylate (aspirin) poisoning based on serum salicylate level and hours post-ingestion
Score interpretation
Level below asymptomatic zone for time post-ingestion.
→ Observe for 6 hours. Serial salicylate levels. Activated charcoal if <1h post-ingestion.
Mild toxicity predicted — tinnitus, nausea, vomiting, hyperventilation.
→ IV fluids. Serial salicylate and pH. Oral activated charcoal. Contact Poisons Information.
Moderate toxicity — confusion, diaphoresis, tachypnoea, electrolyte disturbance.
→ IV urinary alkalinisation (sodium bicarbonate). Monitor K⁺ closely. Aim urine pH 7.5–8.5. Poisons review.
Severe toxicity — coma, seizures, ARDS, renal failure, cardiovascular collapse.
→ HDU/ICU. Urgent haemofiltration/haemodialysis. Poisons unit involvement mandatory. Avoid intubation if possible (worsens acidosis).
Interpretation bands for the Done Nomogram. Apply clinical judgement and local guidance.
References
- Done AK. Salicylate intoxication: significance of measurements of salicylate in blood in cases of acute ingestion. Pediatrics. 1960;26:800–807.
- TOXBASE. Aspirin — Management of Overdose. NPIS UK.
Related
Curated clinical cross-links plus same-class fallbacks.
- Sodium Bicarbonate · Alkalising Agent / Electrolyte
- Aspirin (Antiplatelet — ACS/PCI) · Antiplatelet / ACS
- Aspirin · Antiplatelet / NSAID / Antipyretic / Analgesic
- Diethyl phthalate with methyl salicylate · Topical rubefacient (counterirritant)
- Sodium Bicarbonate 8.4% · Electrolyte Buffer
- Aspirin (Loading Dose) · Antiplatelet — ACS / Ischaemic Stroke
- Difficult Airway Algorithm (DAS) · DAS 2015; Royal College of Anaesthetists
- Major Haemorrhage Protocol · NICE NG24; UK MHP guidelines
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Featured in these MRCEM clinical pathways
The Done Nomogram is covered in detail — with RCEM/NICE evidence base, indications and pitfalls — in the following exam-focused pathways on our sister siteReviseMRCEM.
MRCEM Primary / Intermediate / OSCE candidates: each pathway includes exam-style questions, RCEM/NICE citations, and FAQ summaries.
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.