What CIWA-Ar score indicates need for benzodiazepine treatment?

CIWA-Ar 15: severe, aggressive treatment; >20 or DT: ICU admission indicated.

What is the symptom-triggered vs fixed-schedule approach?

Symptom-triggered (CIWA-driven PRN dosing) reduces total benzodiazepine use 50% and shortens treatment duration vs fixed schedule; CIWA-Ar reassessed every 1-2h; treat if score >8-10; do not treat below threshold.

What is delirium tremens and its mortality?

Delirium tremens (DT): confusion, severe autonomic instability (hyperthermia, tachycardia, hypertension, diaphoresis), and hallucinations 48-72h after last drink; untreated mortality 5-15%; with ICU treatment 0-1%; always admit DT to ICU.

When should phenobarbital be used for alcohol withdrawal?

Phenobarbital 260-520 mg IV as adjunct when benzodiazepine doses become very high (>80 mg diazepam equivalent in first 6h); loading dose 10-20 mg/kg IV; reduces ICU LOS and benzodiazepine requirements in refractory withdrawal.

What thiamine dose is required with alcohol withdrawal treatment?

Thiamine 500 mg IV TID x 3 days before any glucose administration (Pabrinex in UK; thiamine 100 mg BID-TID minimum); prevents Wernicke-Korsakoff syndrome; giving glucose without thiamine in thiamine-deficient patients precipitates encephalopathy.

Alcohol Withdrawal (CIWA-Ar) Severity and Benzodiazepine Protocol

Calculates the Clinical Institute Withdrawal Assessment for Alcohol scale revised (CIWA-Ar) with benzodiazepine PRN dosing thresholds, phenobarbital adjunct criteria, and ICU admission indications for severe alcohol withdrawal.

Weight

Height

Clinical Guidance

BMI is a screening measure of body size, not a direct measure of body fat. The standard WHO categories are underweight (<18.5), normal (18.5–24.9), overweight (25–29.9), and obese (≥30).

BMI can overestimate body fat in athletes with high muscle mass and underestimate it in older adults with low muscle mass. Interpret it alongside waist circumference and clinical context rather than as a standalone diagnosis.

⚕ Clinical Disclaimer: These calculators are for educational and reference purposes only. Always verify results with qualified clinical judgment and current clinical guidelines. Do not use as a sole basis for medical decisions.

How to Use

Enter the values for the patient or scenario you are assessing. Calculates the Clinical Institute Withdrawal Assessment for Alcohol scale revised (CIWA-Ar) with benzodiazepine PRN dosing thresholds, phenobarbital adjunct criteria, and ICU admission indications for severe alcohol withdrawal. Use the ciwa-ar score result to inform your clinical assessment.

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