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Glasgow Assessment and Management of Alcohol
If you would like further information or advice on the alcohol screening and withdrawal management guideline(GMAWS) please contact your local acute addiction liaison nurse service; Glasgow Hospitals and Vale of Leven: 0141 211 2835
Royal Alexandra Hospital: 0141 314 4472
Inverclyde Royal Hospital: 01475 715 353

Glasgow Assessment and Management of Alcohol

Please Attach Patient Label
Alcohol By Volume (ABV%)
Average Units
(ABV% x Vol)
Strong Lager 9% (440mls)
4.0 Units
Beer/ Lager 4.5% (Pint/500mls Can/Bottle)
2.2 Units
CHI: CRN: _
Wine (e.g.Buckfast) 15% (750mls)
11.0 Units
(Table) 12% (750mls)
9.0 Units
Wine (Table) 12% (175ml glass)
2.1 Units
Name: Dob: _
Alcopops 5% (330mls)
1.5 Units
Spirits 40% (25ml measure)
Address:
Spirits 40% (¼ bottle 175mls)
7.0 Units
s 40% (Litre)
40.0 Units
Spirits 40% (700mls)
30.0 Units
Cider 4% (Litre)
4.0 Units
Postcode:
Cider 4% (440mls)
1.8 Units
Strong White Cider 8% (Litre)
8.0 Units
Strong White Cider 8% (300ml glass)
2.4 Units
Number of Units = ABV (%) x Volume (litres)
eg A bottle of wine (750mls) which is 12% ABV = 12 x 0.75 = 9 Units
A glass of wine (200mls) which is 12% ABV = 12 x 0.2 = 2.4 Units Estimated Weekly Alcohol Units :
Excessive Weekly Consumption
(Daily Units x Number of Days per Week)
(♂: >21 units/week; ♀: >14 units/week)

Estimated
Date / Time Of Last Drink ( If ≥ 5 Days, Re-consider Alcohol Withdrawal Status )
Presents With (or has Previous History of) Alcohol Related Seizures
Presents With (or has Previous History of) Severe Alcohol Withdrawal

Fast Alcohol Screening Tool - FAST:

Note : 1 drink = 1 unit of alcohol (refer to table above)
Score of 3
1. MEN: How often do you have EIGHT or more drinks on one occasion?
WOMEN: How often do you have SIX or more drinks on one occasion?
Positive
0 Less than monthly
1 Monthly
3 Daily or almost daily
2. How often during the last year have you been unable to remember what happened the night
before because you had been drinking?
Never
0 Less than monthly
1 Monthly
3 Daily or almost daily
3. How often during the last year have you failed to do what was normally expected of you
because of drinking?
FAST Positive?
0 Less than monthly
1 Monthly
3 Daily or almost daily
4. In the last year has a relative or friend, or a doctor or other health worker been concerned
about your drinking or suggested you cut down?
0 Yes, on one occasion
2 Yes, on more than one occasion
FAST 0-2:
Negative: No action required.
FAST 3-8:
Hazardous Drinking: Advise regarding safe drinking levels and offer information leaflet / advice.
FAST 9-16:
Probable Dependent Drinking: Advice as above and consider referral to Addiction Liaison Service.
PLEASE INSERT IN PATIENT'S CASE RECORD ON COMPLETION OF TREATMENT
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Content cannot be amended without permission
Vitamin Prophylaxis and Treatment of Wernicke-Korsakoff Encephalopathy
The guidance applies to patients who are chronic alcohol abusers. This includes those who are dependent on alcohol but also those who have a hazardous/ harmful alcohol intake. Assess the risk of We
rnicke's encephalopathy
Does the patient have any of the followin g signs/ symptoms? Confusion/ agitation Decreased consciousness Ophthalmoplegia Hypothermia/ hypotension Overt/ incipient Wernicke's Does the patient have 2 or more of the following signs/ symptoms?  Malnourished  Weight loss/ / poor diet Pabrinex IV,
2 pairs of vials three times
daily for three days.
N.B. Check for and correct
Pabrinex IV/IM,
1 pair of v ials once
for three days.
til confusion
Low risk of Wernicke's Then step down to … resolves –
whichever
is longer.)
Thiamine, oral 100mg
Then step down to … three times daily
Important notes

 Patients with overt/ incipient Wernicke's encephalopathy or ‘at risk' of Wernicke's encephalopathy must
be given Pabrinex® before the administration of glucose or nutritional support.
 Intravenous Parbinex® should be administered over 30 minutes  Anaphylaxis is a rare complication of IV Pabrinex® administration and even more uncommon with IM administration. Monitor patient for wheeze, tachycardia, breathlessness and skin rash. Facilities for the administration of adrenaline and other resuscitation should be available  Further vitamin supplementation as clinically indicated by responsible medical team in the context of a general nutritional assessment Management of Alcohol Withdrawal Syndrome
DEPENDENT DRINKING
ON SCREENING - HIGH RISK
Any 2 of the following: Presents with or has had pr evious withdrawal seizures Previous severely agita ted withdrawal (D.T.'s) High screening score (FAST High initial symptom score FIXED DOSE DIAZEPAM SYMPTOM TRIGGERED TREATMENT SYMPTOM TRIGGERED TREATMENT Have you considered exceptional patient groups
Have you considered exceptional patient groups

BASELINE TREATMENT REGIME
Fixed Dose oral Diazepam: (for patients unable to tolerate diazepam via the oral route, see below).
Initial 24 hours:
20mg Diazepam 6 hourly
If no additional symptom triggered treatment, then REDUCE as follows:
15mg Diazepam 6 hourly for 24 hours 10mg Diazepam 6 hourly for 24 hours 5mg Diazepam 6 hourly for 24 hours 5mg Diazepam 12 hourly for 24 hours Diazepam prescription to be reviewed if patient excessively drowsy. Maximum of 120mg Diazepam in 24 hours, before requesting senior medical review. (*Diazepam 120mg not expected to be problematic over 24hrs in uncomplicated patients). EXCEPTIONAL PATIENT GROUPS:
 Patients with evidence of liver disease: especially jaundice, encephalopathy  Patients with other significant co-morbidity (i.e. COPD, pneumonia, cerebrovascular disease, reduced GCS) Consider the use of oral Lorazepam in these exceptional patient groups in a symptom triggered fashion: 1-2 mg (to a maximum of 12mg in 24 hours before requesting senior medical review). Note: Lorazepam has a slower onset of peak effect but ultimately has a more rapid elimination SEVERE WITHDRAWAL (aggressive/ uncontrollable/ dangerous behaviour)
 Intravenous diazemuls up to 40mg over first 30 minutes (up to 2mg/minute; flumazanil to be available)  Adjunctive therapy with Haloperidol 5-10mg IV or IM (smaller doses unlikely to be effective) PATIENTS UNABLE TO TOLERATE ORAL MEDICATION
 Patients unable to tolerate oral medication may receive intravenous therapy (diazemuls or lorazepam) as an alternative at 50% of the oral dose in the first instance, and response assessed INTRAVENOUS BENZODIAZEPINES
 It is recommended that intravenous benzodiazepines are administered by an experienced member of medical staff (FY2 or above)  If nursing staff administer intravenous benzodiazepines they MUST have completed the appropriate Competency Training to administer IV sedation MONITORING
 All patients should be closely observed for signs of over-sedation with regular observations  Exceptional Patient Groups (see above), patients with Severe Withdrawal and patients requiring Intravenous or Intramuscular Sedation require close monitoring (NEWS) ideally with one-to-one nursing care  Consultation regarding intensive care support may be necessary in extreme situations APPROXIMATE ORAL BENZODIAZEPINE EQUIVALENCE
10mg Diazepam = 1mg Lorazepam = 30mg Chlordiazepoxide

Patients should not be discharged on regular benzodiazepine unless there is a confirmed arrangement with the
Community Addiction Services. Chlordiazepoxide is the recommended benzodiazepine for community use.

Glasgow Modified Alcohol Withdrawal Scale (GMAWS) Treatment Option: GMAWS Only
GMAWS & Fixed Dose
0) No tremor 1) On movement 2) At rest
Sweating
0) No sweat visible 1) Moist 2) Drenching sweats
Hallucination
0) Not present 1) Dissuadable 2) Not dissuadable
Orientation
1) Vague, detached
2) Disorientated, no contact
Agitation
0) Calm
1) Anxious
2) Panicky
Score

Treatment
Staff Signature
Score: (Do not use scoring tool if patient intoxicated, must be at least 8 hours since last drink.)
0 : Repeat Score in 2 hours (Discontinue after scoring on 4 consecutive occasions, except if less than 48hrs after last drink) 1 – 3 : Give 10mg Diazepam: Repeat Score in 2 hours 4 – 8 : Give 20mg Diazepam : Repeat Score in 1 hour 9 - 10 : Give 20mg Diazepam : Repeat Score in 1 hour, and discuss with medical staff regarding management of severe withdrawal as per guideline (see page 3) PATIENTS MAY REQUIRE TO BE WOKEN FOR CONTINUING ASSESSMENT
CO-EXISTING ILLNESS MAY AFFECT SCORE: SEEK MEDICAL ADVICE IF IN DOUBT
FIXED DOSING & SYMPTOM TRIGGERED DOSING MUST BE NO LESS THAN 1 HOUR APART
All patients should have regular observations documented. Patients receiving high doses of Diazepam should be assessed regularly for over sedation.
Regular NEWS – Frequency 1-4hrs. (GCS, Respiration rate. Oxygen satn, Pulse, Blood Pressure)
Developed by the Acute Alcohol Screening & Withdrawal Management Guideline Group
Published April 2011
Chaired by Dr Ewan Forrest, Consultant Physician and Gastroenterologist, GRI
Review Date April 2016
Copyright : This is the Property of NHS Greater Glasgow and Clyde. Free to be used across NHS UK. Do not remove logos. Content cannot be amended without permission
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