Gastrointestinal

Why is AST/ALT 2:1 in Alcoholic Hepatitis?

Patients with alcoholic hepatitis almost always have liver markers levels less than 500 IU/L and often have a ratio AST/ALT of 2:1. Elevated gamma-glutamyl transferase supports the diagnosis.

THEORY:
1. ALT= Liver cytoplasmic enzyme (specific for liver cell necrosis). AST= mitochondrial enzyme

  • Ethanol (Alcohol) damages the mitochondrial membrane, which is critical to dealing with reactive oxygen species (ROS). Excess ethanol may overwhelm the mitochondria with oxidative stress leading to cellular damage/death. This in term causes increased leakage of mitochondria AST (mAST) into the bloodstream.

2. Decreased ALT activity most likely due to B6 depletion in the livers of alcoholics

REFERENCES

  1. Botros M, Sikaris KA. The De Ritis Ratio: The Test of Time. The Clinical Biochemist Reviews. 2013;34(3):117-130.
  2. Matloff DS, Selinger MJ, Kaplan MM. Hepatic transaminase activity in alocholic liver disease. Gastroenterology. 1980 Jun; 78(6):1389-92.
  3. Ishii H, Okuno F, Shigeta Y, Tsuchiya M. Enhanced serum glutamic oxaloacetic transaminase activity of mitochondrial origin in chronic alcoholics. Curr Alcohol. 1979; 5():101-8.
  4.  Serum gamma-glutamyl transpeptidase and chronic alcoholism. Influence of alcohol ingestion and liver disease. Dig Dis Sci 30 (3): 211–4. Mar 1985. doi:10.1007/bf01347885. PMID 2857631.
Get Medical Pearls directly to your inbox every week!
Weekly posts with high yield medical knowledge, directly to your mailbox!
Dr. C Humphreys

Internal Medicine

Share
Published by
Dr. C Humphreys

Recent Posts

What is Peribronchovascular Distribution on CT imaging?

A common finding described on computed tomography (CT) imaging. A disease with a peribronchovascular distribution…

2 weeks ago

Trapped Lung vs. Lung Entrapment

Though often used synonymously; Trapped Lung and Lung Entrapment technically describe separate entities along the…

7 months ago

Cause of Pericardial Effusion in Pulmonary Hypertension: Pathogenesis

It is not clearly understood why patients with pulmonary hypertension (PH) develop pericardial effusions. However,…

8 months ago

Difference between Mycophenolate Mofetil vs. Mycophenolate Sodium

The two drugs are not interchangeable nor dose equivalents. Mycophenolate mofetil (Cellcept) is a semi…

9 months ago

What is an “Anephric” Creatinine Rise?

Serum Creatinine can be a deceptive surrogate during an acute kidney injury. It may lag…

1 year ago

Macrophage activation syndrome vs. Hemophagocytic lymphohistiocytosis

Macrophage activation syndrome (MAS) is a life-threatening complication of rheumatic diseases (i.e SLE, Juvenile idiopathic…

2 years ago

This website uses cookies.