The De Ritis ratio (AST/ALT) is used clinically. A ratio >2 in acute hepatocellular injury most strongly suggests which underlying etiology?

• A Viral hepatitis A
• B Ischemic hepatitis
• C Drug-induced hepatotoxicity (hepatocellular pattern)
• D Alcoholic hepatitis ✓

Explanation

A De Ritis ratio (AST/ALT) >2 is characteristic of alcoholic hepatitis, resulting from mitochondrial AST release and PLP-dependent reduction of ALT synthesis. In viral hepatitis A and most drug-induced hepatocellular injuries, the ratio is typically <1 because ALT is predominantly cytosolic and reflects membrane integrity loss. Ischemic hepatitis can cause very high transaminases but usually shows AST/ALT ratio near 1 with disproportionate LDH elevation. The >2 ratio specifically suggests alcohol-mediated damage.

Reference: Harper's Illustrated Biochemistry, 32nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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