Final answer:
Lorazepam is the best initial treatment for alcohol withdrawal in a patient with advanced liver disease (Child's class C cirrhosis) due to its short-acting profile and extrahepatic metabolism, reducing the risk of liver strain and accumulation.
Step-by-step explanation:
The best initial treatment option for alcohol withdrawal in a patient who is Child's class C cirrhotic is b) Lorazepam; Short-acting, extrahepatic metabolism. This is because Child's class C cirrhosis indicates advanced liver disease, and medications metabolized outside the liver (extrahepatic metabolism) are preferable to avoid further liver strain. Lorazepam is a benzodiazepine with a short half-life, and it is primarily metabolized by conjugation in the kidney rather than the liver, making it a safer option for patients with significant hepatic impairment. On the other hand, medications like Chlordiazepoxide and Diazepam are primarily metabolized in the liver (hepatic metabolism) and could accumulate in patients with liver failure, increasing the risk of adverse effects. Oxazepam does have an extrahepatic metabolism; however, it is not short-acting, which could potentially lead to an accumulation and increased sedative effects in a cirrhotic patient.