CIWA-A Case Study

CIWA-Ar is a 10-item scale which numerically scores the severity of a patient’s nausea, sweating, agitation, headache, anxiety, tremor, sensory disturbances (visual, tactile, and auditory), and orientation23 to determine appropriate benzodiazepine dose. It is usually administered by a nurse and takes only a minute or two to complete. There is a maximum of 67 points and a score >18 indicates a patient is at severe risk for major alcohol withdrawal complications.5 Patients with scores <8 may be reevaluated every 8 hours, however patients with higher CIWA scores will need to be reevaluated more frequently depending on worsening or improving symptoms, sometimes requiring hourly assessments.. Hourly assessments may be quite burdensome for a floor

The CIWA evaluation tool is sometimes replaced with the Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method (CAM) assessment tools when patients reside in the ICU.24 These are well validated tools that evaluate the level of a patient’s agitation versus sedation and presence or absence of

Alternative and adjunctive approaches to treatment of AWS have been investigated in an effort to reduce the untoward side effects associated with large benzodiazepine doses. Blocking the hyperadrenergic symptoms associated with alcohol withdrawal is key in preventing associated morbidity, barbiturates, beta-blockers, propofol, anticonvulsants, and alpha-2 agonists have been studied as adjunctive therapies and should be discussed in more detail. Ethanol has been used as an alternative therapy to benzodiazepines and its role in treatment of AWS will also be discussed.
Carbamazepine, an anticonvulsant, has shown promise in the treatment of AWS, with no difference in adverse events and lower dropout rates in outpatient treatment for mild-to-moderate alcohol withdrawal but its use has not been studied in the ICU setting.
Beta-blockers have been used as an adjunct for treatment of AWS due to blocking of autonomic symptoms with success but should never be used as monotherapy since they have no antiepileptic properties and may not prevent delirium. Propranol has been shown to worsen delirium in some