CIWA-Ar for Alcohol Withdrawal
The CIWA-Ar objectifies severity of alcohol withdrawal.
Result:
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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.
Content Contributors
- Jonathan Avery, MD
- Katherine E. Taylor, MD
