---
title: "Alcohol Withdrawal Checklist"
url: https://mghmclean.org/residents/handbk/part2a/etoh.htm
description: "source : Addiction Research Foundation Clinical Institute Withdrawal Assessment -Alcohol, revised (CIWA-Ar)"
published: 2026-08-10
updated: 2026-08-10
---

# Alcohol Withdrawal Checklist

Published 2026-08-10

PART 3 / CH 23

| **Blood Pressure**< 140/90 0 pt140/90 – 158/98 1160/100- 175/110 2176/110 –199/110 3> 200/110 4 | **Tremors**Inner shakes 0Inner shakes &fine tremor 1Tremor on holdingobjects 2Visible tremors 3Tremor preventingambulation 4 |
|---|---|
| **Anxiety**Mild/able to sit 0Mood swings, freq.purposeful activity 1Easily agitated 2Pacing/nightmares 3Hallucination 4 | **Mental Status**Alert, Ox4 0Forgets simpleinstructions 1Occ. forgets locale 2Confused/ Ox2 3Confused/ Ox1 4 |
| **Pulse**90 or less 091-100 1101-120 2121-139 3140 and above 4 | **Nausea/Vomiting**Occ. nausea 0Nausea, but eatssmall amounts 1Vomits x1 q shift 2Vomits x 2 q shift 3Unable to eat due toneurological status 4 |
| **Diaphoresis**Occ. sweaty palms 0Palms always wet 1Areas of dampclothes 2Beads of sweat seen 3Clothing soaked 4 | **Staging**< 4 points Stage 04-7 points Stage I8-14 points Stage II15-21 points Stage III22 + Stage IV |

*source*: Addiction Research Foundation Clinical Institute Withdrawal Assessment -Alcohol, revised (CIWA-Ar)

## Alcohol Detoxification Protocol

A. In all patients

· Thiamine 100 mg IM x 1, then PO QD x 7 d

· MVI 1 PO QD, Folate 1 mg PO QD

· Check vital signs and staging q 4 hr x 24 hr

B. Proctor I protocol

day 1: Librium 50mg PO q2h PRN x24h; vitals q4h while awake.

day 2: give 75% of total day 1 dose, divided QID

day 3: give 50%, day 4 give 25%, day 5 D/C…

(use Serax 45mg PO q2h PRN x24h when liver disease is present)

C. Alternative protocol

· day 1: check vitals and staging (see chart) q4h;

PRN Stage I or greater (see chart), give either…

- Librium 25-50mg PO q 4-6 hr

- Valium 5-10mg PO q 4-6 hr

- Serax 15-45mg PO q 2-4 hr. (use if hepatic disease present)

· day 2: give 100% of total day 1 dose divided QID;

change vital signs and staging orders to q 6 hours, and monitor for PRN’s usage over the next 24 hrs.

- If none used, decrease benzodiazepine by 50% a day until d/c.

- If additional PRN’s needed, add the amount used to the scheduled amount, and give that amount in *scheduled* *divided doses* over the next 24 hr period.

D. Self-taper protocol (Diazepam front-loading)

· day 1: diazepam 5-10mg PO q20 minutes (less aggressive: 20mg PO q2h) until patient is sedated and no withdrawal signs are noted. Diazepam (and its active metabolite, nordiazepam) will self-taper over next 2-3d.

source: Gastfriend DR, Elman I, Solhkhah R (1998) Psychiatric Clinics of N America: Annual of Drug Therapy.