[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Mental health and psychiatric nursing](https://durgical.com/en/nursing/areas/mental-health/) › Alcohol withdrawal: CIWA-Ar monitoring, seizure and delirium precautions and thiamine before glucose # Alcohol withdrawal: CIWA-Ar monitoring, seizure and delirium precautions and thiamine before glucose - Assessment Know when withdrawal starts, score it regularly with the CIWA-Ar, keep seizure and fall precautions, give thiamine before glucose and call early for delirium. Updated Nov 13, 2026 ## Key points - Mild withdrawal: anxiety, tremor, sweating, palpitations, insomnia, nausea; usually 6–36 hours after the last drink. - Seizures can appear 6–48 hours after the last drink; hallucinations (often visual) 12–48 hours; delirium tremens 48–96 hours. - The CIWA-Ar rates nausea and vomiting, tremor, sweating, anxiety, agitation, tactile, auditory and visual disturbances, headache and orientation; use the scale and cut-offs in your protocol. - Benzodiazepines and other medicines are given per the symptom-triggered protocol, never by guesswork. - Give thiamine before glucose («según protocolo»): glucose first can precipitate Wernicke's encephalopathy (confusion, eye-movement problems, ataxia). - Seizure precautions: bed low, padded rails, suction and oxygen ready at the bedside. ## What it is About half of people with alcohol use disorder have withdrawal when they cut down or stop, and some develop hallucinations, seizures or delirium tremens, which is a medical emergency. Because alcohol use is often under-reported, the nurse watches for withdrawal in any inpatient. The CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol, revised) is the most widely used scale: it rates the main withdrawal symptoms and orientation, and guides symptom-triggered treatment within the institution's protocol. Alongside it, the nurse monitors vital signs, keeps a quiet, safe room with seizure and fall precautions, supports hydration and nutrition and gives the prescribed thiamine before any glucose to prevent Wernicke's encephalopathy. ## Reference values - Mild symptoms: start about 6–36 hours after the last drink and settle within one to two days without treatment. - Seizures: about 6–48 hours. Hallucinations: about 12–48 hours. Delirium tremens: about 48–96 hours. - Delirium tremens: fluctuating attention and cognition with fever, severe tachycardia, hypertension and drenching sweats. - Scores, reassessment intervals and medicine thresholds: those of the institutional protocol. ## What you need - The CIWA-Ar form used by the institution and the symptom-triggered protocol. - Thermometer, blood pressure monitor, pulse oximeter, glucometer. - Suction and oxygen at the bedside; padded rails; low bed. - A quiet room, lit by day and dimly lit at night. ## How to measure it (and why) - Ask about the time of the last drink, the usual amount and past withdrawal, seizures or delirium — this predicts the timing and the risk of severe withdrawal. - Take vital signs and temperature and look for tremor, sweating and agitation — rising pulse, blood pressure and temperature are signs of withdrawal. - Score the CIWA-Ar at the intervals the protocol sets, asking the person and observing them — repeated scores show the trend and trigger treatment. - Give the prescribed medicine when the score reaches the protocol threshold, then reassess — symptom-triggered care prevents seizures and delirium. - Check the orders so that thiamine is given before any glucose-containing fluid or food («según protocolo») — this protects against Wernicke's encephalopathy. - Check capillary glucose as ordered and watch for confusion, eye-movement problems and unsteady gait — these suggest Wernicke's encephalopathy or hypoglycaemia. - Keep the bed low with padded rails, suction and oxygen ready, and help the person to the bathroom — seizures and falls are common risks. - Keep the room quiet and lit, encourage fluids and food, and reorient calmly — a calm setting lowers agitation and prevents falls at night. ## How to read it - A rising CIWA-Ar score despite treatment means withdrawal is worsening: report it. - Over-sedation (difficulty waking, slow breathing) can be a medicine effect: report it per protocol. - Concurrent benzodiazepine or sedative withdrawal raises the seizure risk. - Severe withdrawal is best managed in an intensive care unit; delirium tremens can be fatal without proper care. ## Next step: when to call for help - Call at once for a seizure, hallucinations, new confusion or fluctuating attention, fever or severe tachycardia. - Call if the person is hard to wake or breathing is slow after medicine. - Call if eye-movement problems, ataxia or confusion suggest Wernicke's encephalopathy. - Call if the score keeps rising, the person cannot drink fluids or vomiting persists. ## Test yourself Think of the answer, then tap the question to see it. ## When do alcohol withdrawal seizures and delirium tremens usually appear? Seizures about 6–48 hours after the last drink; delirium tremens about 48–96 hours after it. ## Why is thiamine given before glucose in a person with heavy alcohol use? Giving glucose first can precipitate Wernicke's encephalopathy in someone with thiamine deficiency. ## What is the CIWA-Ar used for? To rate alcohol withdrawal symptoms over time and guide symptom-triggered treatment within the institutional protocol. ## Which seizure precautions apply during alcohol withdrawal? Bed in the lowest position, padded side rails, and suction and oxygen ready at the bedside. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/nursing/alcohol-withdrawal-ciwa-ar-monitoring-seizure-and-delirium-precautions-and-thiam/) ## Connections ## Related 4 - [Substance use from the nursing side: screening, intoxication, harm reduction and recovery](https://durgical.com/en/nursing/substance-use-from-the-nursing-side-screening-intoxication-harm-reduction-and-re/) - [Seizure precautions and care during a seizure](https://durgical.com/en/nursing/seizure-precautions-and-care-during-a-seizure/) - [Neurological checks: level of consciousness, pupils and the Glasgow scale](https://durgical.com/en/nursing/neurological-checks-level-of-consciousness-pupils-and-the-glasgow-scale/) - [Capillary blood glucose testing](https://durgical.com/en/nursing/capillary-blood-glucose-testing/) ## Related conditions 3 - [Alcohol withdrawal and delirium tremens](https://durgical.com/en/conditions/alcohol-withdrawal-and-delirium-tremens/) - [Wernicke encephalopathy (thiamine deficiency)](https://durgical.com/en/conditions/wernicke-encephalopathy/) - [Alcohol use disorder](https://durgical.com/en/conditions/alcohol-use-disorder/) ## In Pharmacology 2 - [Benzodiazepines](https://durgical.com/en/pharmacology/classes/benzodiazepines/) - [Thiamine](https://durgical.com/en/pharmacology/thiamine/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Nursing: Mental Health and Community Concepts, 14.5: Withdrawal management / detoxification](https://med.libretexts.org/Bookshelves/Nursing/Nursing%3A_Mental_Health_and_Community_Concepts_(OpenRN)/14%3A_Substance_Use_Disorders/14.05%3A_Withdrawal_Management_Detoxification) (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2022); [Nursing: Mental Health and Community Concepts, 14.11: Applying the nursing process to substance use disorders](https://med.libretexts.org/Bookshelves/Nursing/Nursing%3A_Mental_Health_and_Community_Concepts_(OpenRN)/14%3A_Substance_Use_Disorders/14.11%3A_Applying_the_Nursing_Process_to_Substance_Use_Disorders) (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts, 2022); [mhGAP Intervention Guide for mental, neurological and substance use disorders in non-specialized health settings, version 2.0](https://www.who.int/publications/i/item/9789241549790) (World Health Organization (WHO), 2016). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/alcohol-withdrawal-ciwa-ar-monitoring-seizure-and-delirium-precautions-and-thiam/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/alcohol-withdrawal-ciwa-ar-monitoring-seizure-and-delirium-precautions-and-thiam/