AbstractTo determine whether hepatic hypoxia is associated with hepatocellular necrosis in alcoholics, oxygen tension in the hepatic vein and hepatic blood flow were determined in thirteen patients without overt clinical liver disease. Ethanol metabolic rate was also assayed as an index of liver metabolism. Hepatic blood flow and ethanol metabolic rate were also determined in six normal volunteers. According to liver histology patients were separated into two groups, with and without hepatocellular necrosis. Alcoholics with necrosis showed a higher (P<0–002) ethanol metabolic rate (405 ± 0–23 mmol/kg/h) than those without necrosis (2–46 ± 0–34). Hepatic blood flow in the total group of alcoholics was not significantly different from controls; in the group with necrosis it was lower (651–7 ± 44–6 ml/min/m2) than in the group without necrosis (878–3 ± 81–6;P<0025). Hepatic vein pO2was lower (P<001) in patients with hepatocellular necrosis (31–7 ± 0–68 mmHg) than in patients without necrosis (35–7 ± 0–99). In the whole group, a significant negative correlation (r= ‐0 76,P<0–003) was observed between hepatic vein pO2and ethanol metabolic rate. Acute administration of ethanol (21–7 mmol/kg) did not alter hepatic blood flow in six normal individuals nor in five alcoholic patients, although an increase in hepatic vein pO2was observed in the latter. The changes observed in hepatic vein pO2, functional hepatic blood flow, and ethanol metabolic rate which correlate with hepatocellular necrosis, may be of pathogenic im