Alcohol withdrawal diagnostic criteria

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Diagnosis

Criteria

History of cessation or reduction in heavy and prolonged alcohol use.
2 or more of:
- Autonomic hypereactivity
- Hand tremor
- Insomnia
- Nausea and vomiting
- Visual or auditory hallucinations
- Psychomotor agitation
- Anxiety
- Grand mal seizures
  Note history of blackouts, morning shakes, prior detoxifications or DTs and frequency, amount and type of alcohol.

Clinical Institute Withdrawal Assessment for Alcohol revised (CIWA-Ar)

The CIWA (Clinical Institute Withdrawal Assessment)^[1] is a common measure used in North American hospitals to assess and treat alcohol withdrawal syndrome and for alcohol detoxification. This clinical tool assesses 10 common withdrawal signs.^[2] A score of more than 15 points is associated with increased risk of alcohol withdrawal effects such as confusion or seizures.

Other Assessment Scales

Alcohol Assessment Scale

Level of Evidence

Assessment Scale	Level of Evidence
The Clinical Institute Withdrawal Assessment for Alcohol Revised (CIWA-Ar)	I
Alcohol Assessment Scale (AWS)	IV

Alcohol Withdrawal Calculator

Nausea and Vomitting
No nausea or vomiting
Intermittent nausea with dry heaves
Constant nausea, frequent dry heaves and vomiting

Paroxysmal Sweats
No sweats visible
Barely perceptible sweat, palms moist
Beads of sweat obvious on forehead
Drenching sweats

Agitation
Normal activity
Somewhat more than normal activity
Moderate fidgety and restless
Paces back and forth during most of the interview or constantly thrashes about

Visual Disturbances
Not present
Very mild photosensitivity
Mild photosensitivity
Moderate photosensitivity
Moderately severe visual hallucinations
Severe visual hallucinations
Extreme severe visual hallucinations
Continuous visual hallucinations

Tremor
No tremor
Not visible, but can be felt at finger tips
Moderate when patient’s hands extended
Severe, even with arms not extended

Tactile Disturbances
Not present
Very mild paraesthesias
Mild paraesthesias
Moderate paraesthesias
Moderately severe paraesthesias
Severe paraesthesias
Extremely severe paraesthesias
Continuous paraesthesias

Headache
Not present
Very mild
Mild
Moderate
Moderately severe
Severe
Very severe
Extremely severe

Auditory Disturbances
Not present
Very mild harshness or ability to frighten
Mild harshness or ability to frighten
Moderate harshness or ability to frighten
Moderately severe hallucinations
Severe hallucinations
Extremely severe hallucinations
Continuous hallucinations

Orientation and Clouding of the Sensorium
Oriented and can do serial additions
Cannot do serial additions
Disoriented for date but not more than 2 calendar days
Disoriented for date by more than 2 calendar days
Disoriented for place/person

References

↑ Puz CA, Stokes SJ (2005). "Alcohol withdrawal syndrome: assessment and treatment with the use of the Clinical Institute Withdrawal Assessment for Alcohol-revised". Crit Care Nurs Clin North Am. 17 (3): 297–304. doi:10.1016/j.ccell.2005.04.001. PMID 16115538. Unknown parameter |month= ignored (help)
↑ McKay A, Koranda A, Axen D (2004). "Using a symptom-triggered approach to manage patients in acute alcohol withdrawal". Medsurg Nurs. 13 (1): 15–20, 31, quiz 21. PMID 15029927. Unknown parameter |month= ignored (help)

[pmid16115538-1] Puz CA, Stokes SJ (2005). "Alcohol withdrawal syndrome: assessment and treatment with the use of the Clinical Institute Withdrawal Assessment for Alcohol-revised". Crit Care Nurs Clin North Am. 17 (3): 297–304. doi:10.1016/j.ccell.2005.04.001. PMID 16115538. Unknown parameter |month= ignored (help)

[pmid15029927-2] McKay A, Koranda A, Axen D (2004). "Using a symptom-triggered approach to manage patients in acute alcohol withdrawal". Medsurg Nurs. 13 (1): 15–20, 31, quiz 21. PMID 15029927. Unknown parameter |month= ignored (help)

[1]

[2]