Glasgow Modified Alcohol Withdrawal Scale (GMAWS)
Glasgow Modified Alcohol Withdrawal Scale (NHS Greater Glasgow and Clyde): 5 signs scored 0–2 — tremor, sweating, hallucinations, orientation, agitation (total 0–10) — for symptom-triggered benzodiazepine treatment of alcohol withdrawal in adults. Do not score while intoxicated: at least 8 hours since the last drink.
Score interpretation
No signs of alcohol withdrawal on this assessment.
→ Repeat the score in 2 hours; stop scoring after 4 consecutive scores of 0 unless it is less than 48 hours since the last drink (GMAWS protocol).
Alcohol withdrawal signs present.
→ Adults: diazepam 10 mg orally (NHS GGC GMAWS protocol). Children: use a children's formulary. Repeat the score in 2 hours; thiamine per local protocol.
Severe alcohol withdrawal (GMAWS ≥ 4 is roughly CIWA-Ar ≥ 16).
→ Adults: diazepam 20 mg orally (NHS GGC GMAWS protocol). Children: use a children's formulary. Repeat the score in 1 hour; watch for over-sedation.
Severe alcohol withdrawal.
→ Adults: diazepam 20 mg orally (NHS GGC GMAWS protocol). Children: use a children's formulary. Repeat the score in 1 hour and discuss management of severe withdrawal with medical staff.
Interpretation bands for the GMAWS. Apply clinical judgement and local guidance.
References
- McPherson A, Benson G, Forrest EH. Appraisal of the Glasgow assessment and management of alcohol guideline: a comprehensive alcohol management protocol for use in general hospitals. QJM. 2012;105(7):649-656.
- Maguire D, et al. A prospective evaluation of thiamine and magnesium status in relation to clinicopathological characteristics and 1-year mortality in patients with alcohol withdrawal syndrome. J Transl Med. 2019;17:384 (Fig. 3 reproduces the GMAWS chart).
Related
Curated clinical cross-links plus same-class fallbacks.
- Chlorhexidine gluconate with isopropyl alcohol · Skin antiseptic
- Hydrocortisone (Oral Replacement) · Glucocorticoid Replacement
- Morphine (Oral) · Strong Opioid Analgesic — Step 3 WHO Ladder
- Oxycodone · Strong Opioid Analgesic — Step 3 WHO Ladder
- Chlorhexidine · Antiseptic / disinfectant (bisbiguanide)
- Alcohol (ethanol) · Antidote / sclerosant
- Acute Behavioural Disturbance / Rapid Tranquillisation · RCEM 2022; RCPsych 2022; NICE NG10
- Self-Harm Presentation · NICE NG225 (2022)
- Capacity Assessment (Mental Capacity Act) · MCA 2005; Code of Practice
- Acute Psychosis Management · NICE CG178 2014
- Depression Management · NICE CG90 2022
- Lithium Therapy Monitoring · NICE CG185
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.