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CIWA-Ar Calculator

Nausea and vomiting
0 = none · 7 = constant with retching
Tremor
0 = none · 7 = severe, even at rest
Paroxysmal sweats
0 = none · 7 = drenching sweats
Anxiety
0 = none · 7 = panic-level
Agitation
0 = normal activity · 7 = pacing or thrashing
Tactile disturbances
0 = none · 7 = continuous hallucinations
Auditory disturbances
0 = none · 7 = continuous hallucinations
Visual disturbances
0 = none · 7 = continuous hallucinations
Headache or fullness in head
0 = none · 7 = extremely severe
Orientation and clouding of sensorium
0 = oriented · 4 = disoriented to place or person
CIWA-Ar score
0 / 67
This calculator is an educational reference only. It does not replace clinical judgment or a withdrawal protocol. CIWA-Ar assumes the patient can communicate, and thresholds for symptom-triggered medication vary by protocol. High scores carry a risk of seizures and delirium tremens. Interpret it in the full clinical context.

What is CIWA-Ar Calculator

The CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, revised) rates the severity of alcohol withdrawal across 10 items: nausea, tremor, sweats, anxiety, agitation, tactile, auditory and visual disturbances, headache, and orientation. Nine items score 0 to 7 and orientation scores 0 to 4, for a maximum of 67. It is the backbone of symptom-triggered benzodiazepine protocols, where the dose follows the score rather than a fixed schedule.

How to use

  1. Assess each of the 10 items at the bedside.
  2. Set the score for each from its dropdown, using the anchors shown.
  3. Read the running total and the severity band below.
  4. Follow your local protocol for the medication threshold.

When to use it

Running a symptom-triggered withdrawal protocol and need to score a patient fast? Rate the 10 items and a total of 8 or below usually means no medication is needed, 9 to 15 is moderate withdrawal, and 16 or more is severe, with a real risk of seizures or delirium tremens. Handy for repeat assessments through a shift, where the trend matters as much as any single number.

Frequently asked questions

What CIWA-Ar score needs treatment?

Many protocols start symptom-triggered benzodiazepines at 8 to 10 and above, but the exact threshold is set locally. A score of 8 or below usually means minimal or absent withdrawal, 9 to 15 moderate, and 16 or more severe.

How high can the CIWA-Ar go?

The maximum is 67: nine items scored 0 to 7 (63 points) plus the orientation item scored 0 to 4. Scores above 20 signal severe withdrawal with a raised risk of seizures and delirium tremens.

When should I not use the CIWA-Ar?

It relies on the patient communicating symptoms, so it is unreliable in intubated, heavily sedated or non-communicative patients, and it is not a diagnostic test for withdrawal. Use clinical judgment and a validated protocol.

Can I share this assessment with the scores pre-filled?

Yes. The URL updates as you set each item. Copy it from the address bar or use the Copy link button, and anyone who opens it sees the same CIWA-Ar score ready to go.

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