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    CIWA-Ar for Alcohol Withdrawal

    Objectifies alcohol withdrawal severity to help guide therapy.
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    Advice

    • Benzodiazepines are generally used to control psychomotor agitation and prevent progression to more severe withdrawal.
    • Diazepam (Valium), lorazepam (Ativan), and chlordiazepoxide (Librium) are the most frequently used benzodiazepines. Follow your hospital's own alcohol withdrawal protocol; frequently treatment begins with benzodiazepines when CIWA-Ar scores reach 8-10, with standing or as needed dosing for scores 10-20. Some protocols even include transfer to the ICU for scores >20.
    • Consider additional supportive care, including intravenous fluids, nutritional supplementation, and frequent clinical reassessment including vital signs.

    Management

    Assessment protocols utilizing CIWA-Ar vary and include medication dosing triggered by symptoms only and combined symptom-triggered + fixed-dose medication dosing.

    Critical Actions

    Other conditions can mimic or coexist with alcohol withdrawal, including:

    • Drug overdose
    • Trauma (eg, intracranial hemorrhage)
    • Infection (eg, meningitis)
    • Metabolic derangements
    • Hepatic failure
    • Gastrointestinal bleeding

    Consider additional testing to rule out alternative diagnoses, especially if presentation includes altered mental status and/or fever.