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CIWA-Ar for Alcohol Withdrawal

Objectifies alcohol withdrawal severity to help guide therapy.

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.