OBJECTIVE To propose a mechanism for ethanol induced hepatocytotoxicity. METHODS Hepatocytotoxicity was determined at various concentrations of oxygen and agents involved in NADH metabolism. RESULTS At 1% O2, hepatocytes were nearly 8-fold more susceptible to ethanol than at 95% O2 (carbogen). Cytotoxicity at 1% O2 was enhanced in the presence of glycolytic substrates that generate NADH (e.g., sorbitol or xylitol), and prevented by glycolytic substrates that reoxidise NADH (e.g., fructose or dihydroxyacetone). Susceptibility to ethanol correlated with the cytosolic redox state (lactate; pyruvate ratio). Cytotoxicity also correlated with reactive oxygen species (ROS) formation. Cytotoxicity was averted by ROS scavengers or the ferric chelator desferoxamine but was increased by hydroxylamine, a catalase inhibitor, or by prior glutathione depletion. Ethanol induced cytotoxicity was also decreased by inhibitors of alcohol/aldehyde dehydrogenases or CYP2E1, an alcohol inducible cytochrome P450. CONCLUSIONS A cytotoxic mechanism was proposed where the sustained increase in NADH levels, resulting from ethanol metabolism, maintains CYP2E1 in a more reduced state that increases ROS formation.