In cases of suspected alcohol withdrawal syndrome, what is the best initial plan for a patient?

In cases of suspected alcohol withdrawal syndrome, the best initial plan is to admit the patient and start diazepam. This approach is appropriate because alcohol withdrawal can present with severe symptoms, including tremors, anxiety, hallucinations, and seizures, which may escalate without medical intervention. Administering a benzodiazepine such as diazepam helps to alleviate withdrawal symptoms, reduce the risk of severe complications, and provide a safe environment for monitoring.

Benzodiazepines are the first-line treatment for alcohol withdrawal due to their effectiveness in managing anxiety and preventing seizures. They work by enhancing GABA-A receptor activity, counteracting the excitatory effects of alcohol withdrawal on the nervous system, thus easing symptoms and supporting the patient's stability.

Discharging the patient would not be safe, as they require observation and possible intervention to prevent serious withdrawal complications. Starting oral naltrexone is inappropriate as it is primarily used for alcohol dependence in abstinent individuals and does not address immediate withdrawal symptoms. Referring to outpatient therapy would similarly be inadequate, as a patient experiencing withdrawal requires immediate and often inpatient care to manage symptoms safely. Thus, admitting the patient and initiating treatment with diazepam is the most clinically sound approach.