What is the first-line treatment for delirium tremens (DTs)?

Benzodiazepines are indeed the first-line treatment for delirium tremens (DTs), which is a severe form of alcohol withdrawal characterized by confusion, agitation, hallucinations, and autonomic instability. The role of benzodiazepines in this context is primarily due to their effectiveness in alleviating withdrawal symptoms and preventing complications. They work by enhancing the effect of gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter in the brain, which helps to calm the overactive neural activity seen in withdrawal.

In cases of DTs, high doses of benzodiazepines may be required, and treatment should be guided by the severity of symptoms. Typical benzodiazepines used include lorazepam and diazepam. This approach not only addresses the acute symptoms but also reduces the risk of progression to more severe complications, including seizures.

The other options do not serve as first-line treatments for DTs. Flumazenil can potentially precipitate seizures in patients who are benzodiazepine-dependent, making it contraindicated. N-acetylcysteine is commonly used as an antidote for acetaminophen overdose, not for alcohol withdrawal. Naloxone is an opioid antagonist used in opioid overdose and would not