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Glasgow Modified Alcohol Withdrawal Scale (GMAWS)

Severity of alcohol withdrawal to guide benzodiazepine dosing.

Glasgow Modified Alcohol Withdrawal Scale (GMAWS)
Tremor
Sweating
Hallucinations
Orientation
Agitation
Result0 points

Alcohol withdrawal severity (range 0-10). No diazepam; repeat score in 2 hours.

Suggested action
No diazepam; repeat score in 2 hours.

When to use

  • Symptom-triggered assessment and benzodiazepine dosing in acute alcohol withdrawal.

Formula

Five items (tremor, sweating, hallucinations, orientation, agitation), each 0-2. Total 0-10. 0: reassess in 2 h; 1-3: diazepam 10 mg; 4-8: diazepam 20 mg; 9-10: diazepam 20 mg plus medical review.

Pearls and pitfalls

  • Do not score an intoxicated patient; use only once at least 8 hours have passed since the last drink.

References

  1. McPherson A, Benson G, Forrest EH. QJM. 2012;105(7):649-56.