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CIWA-Ar for Alcohol Withdrawal
Ten-item scale objectifying the severity of alcohol withdrawal symptoms.
CIWA-Ar for Alcohol Withdrawal
Nausea/vomiting
0 = none, 7 = constant nausea and vomiting
points
Tremor
0 = none, 7 = severe, even with arms not extended
points
Paroxysmal sweats
0 = none, 7 = drenching sweats
points
Anxiety
0 = none, 7 = panic-level anxiety
points
Agitation
0 = normal activity, 7 = constant thrashing
points
Tactile disturbances
0 = none, 7 = continuous hallucinations
points
Auditory disturbances
0 = none, 7 = continuous hallucinations
points
Visual disturbances
0 = none, 7 = continuous hallucinations
points
Headache/fullness in head
0 = none, 7 = extremely severe
points
Orientation and clouding of sensorium
0 = oriented and can do serial additions, 4 = disoriented to place and/or person
points
Complete the fields above to see the result.
When to use
- Objectifying severity of alcohol withdrawal to guide symptom-triggered benzodiazepine dosing.
Formula
Sum of 9 domains scored 0-7 (nausea/vomiting, tremor, sweats, anxiety, agitation, tactile, auditory, and visual disturbances, headache) plus orientation/clouding of sensorium scored 0-4. Maximum 67.
Pearls and pitfalls
- Relies on patient self-report for several items and is unreliable in patients with delirium - use a sedation scale (e.g., RASS) instead in that setting.