Hepatitis A,B, & C can all throw the AST/ALT ratio out of whack.
Liver function panels can give funny results if the phlebotomist didn’t use the right tubes (red top for HEPfx), got a short-draw, or they were not stored properly.
We also used to see some pretty outrageous numbers in the detox clinic (ALT 200+). Apparently drinking isopropyl is bad for your liver.