Glasgow Modified Alcohol Withdrawal Scale (GMAWS)

• Use GMAWS to guide benzodiazepine dosing and reassessment.
• Consider using lorazepam instead of diazepam in patients with liver dysfunction, advanced age, or suspected altered metabolism.
• Monitor for signs of benzodiazepine over-sedation, especially in those with comorbidities.
• Escalate care if symptoms worsen or become refractory to treatment despite repeated dosing.

The GMAWS authors recommend the following symptom-based treatment. However, clinical judgment should be used to evaluate the entire clinical picture prior to administering medications. 

Initiate urgent evaluation and consider ICU transfer or escalation of care if any of the following occur:

• GMAWS ≥8 for more than 1 hour.
• Heart rate >140 or <50 bpm.
• Systolic blood pressure >180 mm Hg or <90 mm Hg.
• Seizures.
• Respiratory rate ≤12/min or signs of hypoventilation.
• Decreased level of consciousness or airway compromise.
• Urine output <0.5 mL/kg/hr.
• Significant comorbid CNS, cardiac, or respiratory conditions.
• Inadequate response to repeated benzodiazepine doses.