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CIWA-Ar

Measures alcohol withdrawal severity in 10 items and guides symptom-triggered benzodiazepine use and level of care.

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Check the population, units and version. The result shows the formula or classification; it does not make an automatic treatment decision.

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Method · Limits of application

CIWA-Ar/Sullivan 1989: 10 items, total 0–67; orientation 0–4

The 1989 CIWA-Ar quantifies alcohol withdrawal severity using 10 items. Availability of the total does not establish a benzodiazepine indication or dose, level of care, or applicability to patients who cannot be adequately assessed. These elements require the clinical protocol and population for the version used.

Required fields: 0/10 completed

Complete all required fields. Optional fields are marked.

Nausea and vomiting required

Tremor (arms extended and fingers spread) required

Paroxysmal sweating required

Anxiety required

Agitation required

Tactile disturbances (itching, tingling, burning, sensation of insects on the skin) required

Auditory disturbances (sounds louder or harsher, hearing things that are not there) required

Visual disturbances (brighter light, different colors, seeing things that are not there) required

Headache or fullness in the head required

Orientation and sensorium required

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Conditions of use

Check the population, units, inclusion and exclusion criteria, and version in the original source. A result alone does not establish a diagnosis, discharge decision or prescription.

Documented parameters

Nausea and vomiting
Tremor (arms extended and fingers spread)
Paroxysmal sweating
Anxiety
Agitation
Tactile disturbances (itching, tingling, burning, sensation of insects on the skin)
Auditory disturbances (sounds louder or harsher, hearing things that are not there)
Visual disturbances (brighter light, different colors, seeing things that are not there)
Headache or fullness in the head
Orientation and sensorium

4/4 reference cases checked. Numerical tests are not clinical validation.

Sources and documentation

Documented formula

Transcribed from the source or a recorded revision; this is not a clinical recommendation.

Nine items 0–7 (nausea/vomiting, tremor, sweating, anxiety, agitation, tactile, auditory and visual disturbances, headache), and orientation 0–4. Total 0–67. Option texts are instrument anchors; intermediate values are left to the examiner.

References

Identifier: ciwa-ar

Original clinical content: Brazilian Portuguese.

Method version

CIWA-Ar/Sullivan 1989: 10 items, total 0–67; orientation 0–4

ciwa-ar@native-2026-10-03+29e2b50399fd

Source for the active edition

The bibliographic edition identifies the source. By itself, it proves neither full conformity of the formula nor clinical approval.

Synthetic cases checked (4)

Synthetic cases for checking the implementation, with no patient data.

Case 1

reference-001

Inputs

Nausea and vomiting: 0 – No nausea or vomiting
Tremor (arms extended and fingers spread): 0 – No tremor
Paroxysmal sweating: 0 – No visible sweating
Anxiety: 0 – No anxiety, at ease
Agitation: 0 – Normal activity
Tactile disturbances (itching, tingling, burning, sensation of insects on the skin): 0 – Absent
Auditory disturbances (sounds louder or harsher, hearing things that are not there): 0 – Absent
Visual disturbances (brighter light, different colors, seeing things that are not there): 0 – Absent
Headache or fullness in the head: 0 – Absent
Orientation and sensorium: 0 – Oriented and performs serial additions

{
  "nausea": "0",
  "tremor": "0",
  "sudorese": "0",
  "ansiedade": "0",
  "agitacao": "0",
  "tatil": "0",
  "auditivo": "0",
  "visual": "0",
  "cefaleia": "0",
  "orientacao": "0"
}

Expected result

{
  "score": 0,
  "level": "low"
}

Actual result

{
  "score": 0
}

Case 2

reference-002

Inputs

Nausea and vomiting: 1 – Mild nausea without vomiting
Tremor (arms extended and fingers spread): 1 – Not visible, but felt fingertip to fingertip
Paroxysmal sweating: 1 – Barely perceptible sweating, moist palms
Anxiety: 2
Agitation: 1 – Slightly more activity than normal
Headache or fullness in the head: 1 – Very mild
Tactile disturbances (itching, tingling, burning, sensation of insects on the skin): 0 – Absent
Auditory disturbances (sounds louder or harsher, hearing things that are not there): 0 – Absent
Visual disturbances (brighter light, different colors, seeing things that are not there): 0 – Absent
Orientation and sensorium: 0 – Oriented and performs serial additions

{
  "nausea": "1",
  "tremor": "1",
  "sudorese": "1",
  "ansiedade": "2",
  "agitacao": "1",
  "cefaleia": "1",
  "tatil": "0",
  "auditivo": "0",
  "visual": "0",
  "orientacao": "0"
}

Expected result

{
  "score": 7,
  "level": "low"
}

Actual result

{
  "score": 7
}

Case 3

reference-003

Inputs

Nausea and vomiting: 1 – Mild nausea without vomiting
Tremor (arms extended and fingers spread): 4 – Moderate with arms extended
Paroxysmal sweating: 4 – Obvious beads of sweat on the forehead
Anxiety: 4 – Moderately anxious or guarded (anxiety inferred)
Agitation: 3
Tactile disturbances (itching, tingling, burning, sensation of insects on the skin): 0 – Absent
Auditory disturbances (sounds louder or harsher, hearing things that are not there): 0 – Absent
Visual disturbances (brighter light, different colors, seeing things that are not there): 0 – Absent
Headache or fullness in the head: 0 – Absent
Orientation and sensorium: 0 – Oriented and performs serial additions

{
  "nausea": "1",
  "tremor": "4",
  "sudorese": "4",
  "ansiedade": "4",
  "agitacao": "3",
  "tatil": "0",
  "auditivo": "0",
  "visual": "0",
  "cefaleia": "0",
  "orientacao": "0"
}

Expected result

{
  "score": 16,
  "level": "mid"
}

Actual result

{
  "score": 16
}

Case 4

reference-004

Inputs

Tremor (arms extended and fingers spread): 7 – Severe even with arms not extended
Paroxysmal sweating: 4 – Obvious beads of sweat on the forehead
Anxiety: 5
Agitation: 4 – Moderately restless
Tactile disturbances (itching, tingling, burning, sensation of insects on the skin): 3 – Moderate
Visual disturbances (brighter light, different colors, seeing things that are not there): 2 – Mild
Orientation and sensorium: 2 – Disoriented about the date by up to 2 days
Nausea and vomiting: 0 – No nausea or vomiting
Auditory disturbances (sounds louder or harsher, hearing things that are not there): 0 – Absent
Headache or fullness in the head: 0 – Absent

{
  "tremor": "7",
  "sudorese": "4",
  "ansiedade": "5",
  "agitacao": "4",
  "tatil": "3",
  "visual": "2",
  "orientacao": "2",
  "nausea": "0",
  "auditivo": "0",
  "cefaleia": "0"
}

Expected result

{
  "score": 27,
  "level": "high"
}

Actual result

{
  "score": 27
}

Code and reproducibility

This tool’s code on GitHub

Download code and tests

Sources, version and reproduction instructions

The code tests are technical checks. Clinical approval and professional translation review are recorded separately.

Relationship with cancer research

General context — relationship to be defined

A resource for general clinical contexts. This edition does not assign a specific oncological relationship; selecting it for a study requires a justified question, population and purpose.