CIWA-Ar is the most widely used scale for monitoring alcohol withdrawal in hospitals. Each of nine items is rated 0–7 and orientation 0–4, for a maximum of 67. It should be used by trained staff; severe withdrawal can cause seizures and delirium tremens and is a medical emergency.
How to use the CIWA-Ar Calculator
- Nausea and vomiting
- Tremor (arms extended, fingers spread)
- Paroxysmal sweats
- Anxiety
- Agitation
- Tactile disturbances (itching, pins and needles, crawling)
- Auditory disturbances
- Visual disturbances
- Headache or fullness in the head
- Orientation and clouding of sensorium
Results update as you type, and every field accepts the units shown in its menu.
How it works
Each answer carries the points shown in the published score. The calculator adds them up and maps the total to the published interpretation.
Scoring table
| Item | Answers and points |
|---|---|
| Nausea and vomiting | 0 – none = 0; 1 – very mild = 1; 2 = 2; 3 = 3; 4 – moderate = 4; 5 = 5; 6 = 6; 7 – severe or continuous = 7 |
| Tremor (arms extended, fingers spread) | 0 – none = 0; 1 – very mild = 1; 2 = 2; 3 = 3; 4 – moderate = 4; 5 = 5; 6 = 6; 7 – severe or continuous = 7 |
| Paroxysmal sweats | 0 – none = 0; 1 – very mild = 1; 2 = 2; 3 = 3; 4 – moderate = 4; 5 = 5; 6 = 6; 7 – severe or continuous = 7 |
| Anxiety | 0 – none = 0; 1 – very mild = 1; 2 = 2; 3 = 3; 4 – moderate = 4; 5 = 5; 6 = 6; 7 – severe or continuous = 7 |
| Agitation | 0 – none = 0; 1 – very mild = 1; 2 = 2; 3 = 3; 4 – moderate = 4; 5 = 5; 6 = 6; 7 – severe or continuous = 7 |
| Tactile disturbances (itching, pins and needles, crawling) | 0 – none = 0; 1 – very mild = 1; 2 = 2; 3 = 3; 4 – moderate = 4; 5 = 5; 6 = 6; 7 – severe or continuous = 7 |
| Auditory disturbances | 0 – none = 0; 1 – very mild = 1; 2 = 2; 3 = 3; 4 – moderate = 4; 5 = 5; 6 = 6; 7 – severe or continuous = 7 |
| Visual disturbances | 0 – none = 0; 1 – very mild = 1; 2 = 2; 3 = 3; 4 – moderate = 4; 5 = 5; 6 = 6; 7 – severe or continuous = 7 |
| Headache or fullness in the head | 0 – none = 0; 1 – very mild = 1; 2 = 2; 3 = 3; 4 – moderate = 4; 5 = 5; 6 = 6; 7 – severe or continuous = 7 |
| Orientation and clouding of sensorium | 0 – oriented, can do serial additions = 0; 1 – cannot do serial additions or uncertain about date = 1; 2 – date off by no more than 2 days = 2; 3 – date off by more than 2 days = 3; 4 – disoriented for place and/or person = 4 |
Inputs explained
| Field | What to enter |
|---|---|
| Nausea and vomiting | Choose one: 0 – none, 1 – very mild, 2, 3 … |
| Tremor (arms extended, fingers spread) | Choose one: 0 – none, 1 – very mild, 2, 3 … |
| Paroxysmal sweats | Choose one: 0 – none, 1 – very mild, 2, 3 … |
| Anxiety | Choose one: 0 – none, 1 – very mild, 2, 3 … |
| Agitation | Choose one: 0 – none, 1 – very mild, 2, 3 … |
| Tactile disturbances (itching, pins and needles, crawling) | Choose one: 0 – none, 1 – very mild, 2, 3 … |
| Auditory disturbances | Choose one: 0 – none, 1 – very mild, 2, 3 … |
| Visual disturbances | Choose one: 0 – none, 1 – very mild, 2, 3 … |
| Headache or fullness in the head | Choose one: 0 – none, 1 – very mild, 2, 3 … |
| Orientation and clouding of sensorium | Choose one: 0 – oriented, can do serial additions, 1 – cannot do serial additions or uncertain about date, 2 – date off by no more than 2 days, 3 – date off by more than 2 days … |
Health note: this calculator is for education and screening only and is not a diagnosis or treatment advice. Discuss your results with a qualified clinician.
Formula
Score = sum of the points for each item
Worked example
Inputs — Nausea and vomiting: 0 – none; Tremor (arms extended, fingers spread): 1 – very mild; Paroxysmal sweats: 0 – none; Anxiety: 1 – very mild; Agitation: 0 – none; Tactile disturbances (itching, pins and needles, crawling): 0 – none; Auditory disturbances: 0 – none; Visual disturbances: 0 – none; Headache or fullness in the head: 0 – none; Orientation and clouding of sensorium: 0 – oriented, can do serial additions.
Results — CIWA-Ar score = 2 / 67; Withdrawal severity = Absent or minimal (under 10).
Key terms
- Delirium tremens
- Severe alcohol withdrawal with confusion, hallucinations and autonomic instability.
Frequently asked questions
What CIWA score needs medication?
Many protocols treat at 8–10 or more; follow your hospital protocol.
How often is CIWA scored?
Typically every 1–4 hours during active withdrawal.
Can CIWA be used if the patient cannot communicate?
No – it relies on the patient's answers; other scales are used.