Record blood alcohol concentration bac by breathalyzer or blood sample. Outpatient management of alcohol withdrawal syndrome. Scores of less than 8 to 10 indicate minimal to mild withdrawal. Scores of 8 to 15 indicate moderate withdrawal marked autonomic arousal. Patients frequently underreport alcohol use and physicians often overlook alcohol problems in patients. Clinical institute withdrawal assessment of alcohol scale, revised. The ciwa ar the clinical institute withdrawal assessment for alcohol revised assessment is a tool to aid the clinician in determining the best course of intervention 5. This material is intended for use by clinicians only and is provided on an as is, where is basis.
Withdrawal severity total score of withdrawal total score of 2 5 is mild to moderate withdrawal total score of 6 is severe withdrawal. It has been well validated in patients with alcohol withdrawal, but cannot be used for patients with delirium tremens. Clinical institute withdrawal assessment scale benzodiazepines guide to the use of the clinical withdrawal assessment scale for benzodiazepines. Alcohol withdrawal assessment scoring guidelines ciwa ar. Alcohol withdrawal management protocol page 2 of 2 nausea or vomiting, transient visual, tactile or auditory hallucinations or illusions, psychomotor agitation, anxiety, grand mal seizures. Otherwise, patients may be treated using the mildmoderate treatment protocol. Clinical institute withdrawal assessment of alcohol scale. What is clear is that there are significant clinical advantages to quantifying the alcohol withdrawal syndrome. Alcohol withdrawal syndrome guys and st thomas nhs. May begin 48 hours after last drink, last up to 2 weeks tachycardia, hypertension, fever tremor diaphoresis fever confusion, disorientation hallucinations agitation disruption of sleepwake cycle death. The ciwaar provides an efficient assessing alcohol withdrawal that can then be utilized in treatment protocols.
Patients scoring less than 10 do not usually need additional medication for withdrawal. Record patients bac and reported time and date of last alcohol use on ciwaar flowsheet. Management of moderate and severe alcohol withdrawal syndromes. Clinical institute withdrawal assessment for alcoholrevised might. Clinical institute withdrawal assessment of alcohol scale, revised ciwaar the ciwaar scale can measure 10 symptoms. Alcohol withdrawal protocol give thiamine 100mg iv initially and qd po, imiv, folate 1mg qd, mvi qd. University of michigan alcohol withdrawal guidelines overview. Assess current state of withdrawal with ciwaar scoring sheet, attached. The spectrum of alcohol withdrawal symptoms ranges from such minor symptoms as insomnia and tremulousness to severe complications such. No single instrument is significantly superior to others. Symptomtriggered benzodiazepine dosing has been demonstrated to lead to shorter duration of treatment and lower medication use compared with fixed. Alcohol detoxification clinical institute withdrawal assessment of.
Alcohol withdrawal syndrome american family physician. Michigan alcohol withdrawal severity maws score of 6, indicates severe alcohol withdrawal. Alcohol use is a global health concern, ranking seventh among the leading causes of death and disability. Thiamine 100mg tds and vitamin b co strong 2 od should be continued for 2 weeks up to 6 weeks. Although reasonable efforts were made to confirm the. Benzodiazepines are generally used to control psychomotor agitation and prevent progression to more severe withdrawal.
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