CIWA-Ar alcohol withdrawal scale
Alcohol withdrawal severity, used for symptom-triggered benzodiazepine dosing.
Inputs
CompleteNausea and vomiting
Tremor (arms extended)
Paroxysmal sweats
Anxiety
Agitation
Tactile disturbances
Auditory disturbances
Visual disturbances
Headache or fullness in head
Orientation and clouding of sensorium
Worked calculation
Your values are highlighted.
- Points
When to use
- Patients able to communicate during alcohol withdrawal.
Pearls and pitfalls
- Symptom-triggered protocols commonly medicate at scores of 8–10 or higher.
- Not valid in patients who cannot answer questions (use RASS or a sedation scale).
Why use
The standard withdrawal scale in hospitals.
| Criterion | Points |
|---|---|
| Nausea and vomiting: 0: none | 0 |
| 1: mild nausea | +1 |
| 2 | +2 |
| 3 | +3 |
| 4: intermittent nausea with dry heaves | +4 |
| 5 | +5 |
| 6 | +6 |
| 7: constant nausea, frequent vomiting | +7 |
| Tremor (arms extended): 0: none | 0 |
| 1: felt, not visible | +1 |
| 2 | +2 |
| 3 | +3 |
| 4: moderate, arms extended | +4 |
| 5 | +5 |
| 6 | +6 |
| 7: severe, even arms not extended | +7 |
| Paroxysmal sweats: 0: none | 0 |
| 1: barely, palms moist | +1 |
| 2 | +2 |
| 3 | +3 |
| 4: beads on forehead | +4 |
| 5 | +5 |
| 6 | +6 |
| 7: drenching | +7 |
| Anxiety: 0: at ease | 0 |
| 1: mild | +1 |
| 2 | +2 |
| 3 | +3 |
| 4: moderate or guarded | +4 |
| 5 | +5 |
| 6 | +6 |
| 7: acute panic | +7 |
| Agitation: 0: normal activity | 0 |
| 1: somewhat more than normal | +1 |
| 2 | +2 |
| 3 | +3 |
| 4: moderately fidgety | +4 |
| 5 | +5 |
| 6 | +6 |
| 7: paces or thrashes | +7 |
| Tactile disturbances: 0: none | 0 |
| 1: very mild itching or numbness | +1 |
| 2 | +2 |
| 3 | +3 |
| 4: moderately severe hallucinations | +4 |
| 5 | +5 |
| 6 | +6 |
| 7: continuous hallucinations | +7 |
| Auditory disturbances: 0: none | 0 |
| 1: very mild harshness | +1 |
| 2 | +2 |
| 3 | +3 |
| 4: moderately severe hallucinations | +4 |
| 5 | +5 |
| 6 | +6 |
| 7: continuous hallucinations | +7 |
| Visual disturbances: 0: none | 0 |
| 1: very mild sensitivity | +1 |
| 2 | +2 |
| 3 | +3 |
| 4: moderately severe hallucinations | +4 |
| 5 | +5 |
| 6 | +6 |
| 7: continuous hallucinations | +7 |
| Headache or fullness in head: 0: none | 0 |
| 1: very mild | +1 |
| 2 | +2 |
| 3 | +3 |
| 4: moderately severe | +4 |
| 5 | +5 |
| 6 | +6 |
| 7: extremely severe | +7 |
| Orientation and clouding of sensorium: 0: oriented, can do serial additions | 0 |
| 1: cannot do serial additions | +1 |
| 2: date off by 2 days or less | +2 |
| 3: date off by more than 2 days | +3 |
| 4: disoriented to place or person | +4 |