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
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- 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.
- 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.