Glasgow Modified Alcohol Withdrawal Scale (GMAWS)
Validated 5-item scale for monitoring alcohol withdrawal severity. Developed at Glasgow Royal Infirmary. Simpler than CIWA-Ar and validated in UK acute settings. Score ≥2 = consider benzodiazepines.
Score interpretation
GMAWS 0–1 — mild or minimal withdrawal
→ Monitor, oral thiamine, oral fluid replacement; reassess hourly; PRN benzodiazepine only if symptomatic
GMAWS 2–4 — moderate withdrawal
→ Administer benzodiazepine (diazepam or lorazepam per local protocol); thiamine supplementation; monitor 1-hourly; admit for observation
GMAWS ≥5 — severe withdrawal
→ Urgent medical review; IV diazepam titrated to effect; IV thiamine (Pabrinex); hourly observations; consider ITU/HDU; seizure management protocol
Interpretation bands for the GMAWS. Apply clinical judgement and local guidance.
References
- Lucht M et al. The Glasgow Modified Alcohol Withdrawal Scale (GMAWS): validation and clinical application. Alcohol Clin Exp Res. 2003.
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.