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Clinical Institute Withdrawal Assessment for Alcohol

Aka: Clinical Institute Withdrawal Assessment for Alcohol, CIWA-Ar, CIWA Score
  1. Indications: Alcohol Detoxification
    1. Alcohol Withdrawal assessment
    2. Scale used to direct Benzodiazepine protocol
  2. Technique
    1. Each criteria rated on scale of 0 to 7 (except orientation)
    2. Maximum score: 67
  3. Evaluation: Criteria
    1. Nausea, Vomiting
      1. Score 0: None
      2. Score 4: Intermittent
      3. Score 7: Constant
    2. Tremor
      1. Score 0: None
      2. Score 4: Tremor with Arms Extended
      3. Score 7: Severe Tremor at Rest
    3. Paroxysmal Sweating
      1. Score 0: None
      2. Score 1: Palms moist
      3. Score 4: Forehead beads of sweat
      4. Score 7: Drenched
    4. Anxiety
      1. Score 0: None
      2. Score 1: Mild
      3. Score 4: Moderate
      4. Score 7: Severe Panic Attack
    5. Agitation
      1. Score 0: None
      2. Score 4: Fidgets, Restless
      3. Score 7: Paces or thrashes
    6. Tactile Dysfunction
      1. Score 0: None
      2. Score 3: Paresthesias
      3. Score 5: Severe Tactile Hallucinations
      4. Score 7: Continuous Tactile Hallucinations
    7. Auditory Disturbances
      1. Score 0: None
      2. Score 4: Hallucinations
      3. Score 7: Continuous
    8. Visual Disturbances
      1. Score 0: None
      2. Score 2: Mild Light Sensitivity
      3. Score 4: Moderate Visual Hallucinations
      4. Score 7: Continuous Visual Hallucinations
    9. Headache
      1. Score 0: None
      2. Score 3: Moderate
      3. Score 5: Severe
      4. Score 7: Extreme
    10. Orientation
      1. Score 0: Oriented and Can Perform Serial Addition
      2. Score 1: Cannot Perform Serial Addition, Unsure of Date
      3. Score 2: Disoriented Regarding Date, But Within 2 Calendar Days
      4. Score 3: Disoriented Regarding Date By >2 Calendar Days
      5. Score 4: Disoriented to Place
  4. Resources
    1. CIWA-Ar Html version
      1. http://addiction-medicine.org/files/15doc.html
  5. References
    1. Sullivan (1989) Br J Addict 84:1353-7 [PubMed]

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