What is the first-line treatment for managing acute alcohol withdrawal delirium?

Benzodiazepines are recognized as the first-line treatment for managing acute alcohol withdrawal delirium, often referred to as delirium tremens. The primary reason for this choice is that benzodiazepines help to stabilize the central nervous system, which is experiencing hyperactivity due to the absence of alcohol, a central nervous system depressant. These medications help to alleviate symptoms of anxiety, agitation, and seizures which are common in alcohol withdrawal. They are effective at reducing the risk of progression to more severe symptoms, including delirium tremens, and can be titrated based on the severity of withdrawal symptoms.

In the context of acute alcohol withdrawal, other options would not provide the same level of efficacy as benzodiazepines. Intubation is not a treatment for withdrawal itself but rather a supportive measure reserved for patients who are unable to maintain their airway due to severe agitation or altered mental status. Avoidance of physical restraints is a principle of care aimed at maintaining patient dignity and safety, especially since physical restraints can potentially escalate agitation. While antipsychotics may have a role in managing persisting agitation or hallucinations, they are not first-line treatments for the withdrawal process itself and do not address the underlying CNS hyperactivity effectively. Thus, benzodia