Alcohol liver disease: A review of current therapeutic approaches to achieve long-term abstinence

Table 2 Clinical institute withdrawal assessment of alcohol scale, revised (CIWA-ar)

Clinical institute withdrawal assessment of alcohol scale, revised (CIWA-AR)
Patient:_____ Date: _____ Time: _____ (24 h clock, midnight = 00:00)
Pulse or heart rate, taken for one minute:_____ Blood pressure:_____
Nausea and vomiting -- Ask "Do you feel sick to your stomach? Have you vomited?" Observation	Tactile disturbances -- Ask "Have you any itching, pins and needles sensations, any burning, any numbness, or do you feel bugs crawling on or under your skin?" Observation
0 no nausea and no vomiting	0 none
1 mild nausea with no vomiting	1 very mild itching, pins and needles, burning or numbness
2	2 mild itching, pins and needles, burning or numbness
3	3 moderate itching, pins and needles, burning or numbness
4 intermittent nausea with dry heaves	4 moderately severe hallucinations
5	5 severe hallucinations
6	6 extremely severe hallucinations
7 constant nausea, frequent dry heaves and vomiting	7 continuous hallucinations
Visual disturbances -- Ask "Does the light appear to be too bright? Is its color different? Does it hurt your eyes? Are you seeing anything that is disturbing to you? Are you seeing things you know are not there?" Observation	Auditory disturbances -- Ask "Are you more aware of sounds around you? Are they harsh? Do they frighten you? Are you hearing anything that is disturbing to you? Are you hearing things you know are not there?" Observation
0 not present	0 not present
1 very mild sensitivity	1 very mild harshness or ability to frighten
2 mild sensitivity	2 mild harshness or ability to frighten
3 moderate sensitivity	3 moderate harshness or ability to frighten
4 moderately severe hallucinations	4 moderately severe hallucinations
5 severe hallucinations	5 severe hallucinations
6 extremely severe hallucinations7 continuous hallucinations	6 extremely severe hallucinations7 continuous hallucinations
Tremor -- Arms extended and fingers spread apart. Observation	Paroxysmal sweats -- Observation
0 no tremor	0 no sweat visible
1 not visible, but can be felt fingertip to fingertip	1 barely perceptible sweating, palms moist
2	2
3	3
4 moderate, with patient's arms extended	4 beads of sweat obvious on forehead
5	5
6	6
7 severe, even with arms not extended	7 drenching sweats
Anxiety -- Ask "Do you feel nervous?" Observation	Headache, fullness in head -- Ask "Does your head feel different? Does it feel like there is a band around your head?" Do not rate for dizziness or lightheadedness. Otherwise, rate severity
0 no anxiety, at ease	0 not present
1 mild anxious	1 very mild
2	2 mild
3	3 moderate
4 moderately anxious, or guarded, so anxiety is inferred	4 moderately severe
5	5 severe
6	6 very severe
7 equivalent to acute panic states as seen in severe delirium or acute schizophrenic reactions	7 extremely severe
Agitation -- Observation	Orientation and clouding of sensorium -- Ask "What day is this? Where are you? Who am I?"
0 normal activity	0 oriented and can do serial additions
1 somewhat more than normal activity	1 cannot do serial additions or is uncertain about date
2	2 disoriented for date by no more than 2 calendar days
3	3 disoriented for date by more than 2 calendar days
4 moderately fidgety and restless	4 disoriented for place/or person
5
6
7 paces back and forth during most of the interview, or constantly thrashes about
Total CIWA-Ar Score ______
Rater's Initials ______
Maximum Possible Score 67