When perfusion is inadequate, cells in the body’s various tissues are in jeopardy. Kill enough cells, tissue dies. Enough tissue dies, an organ dies. Enough organs die, the patient dies.

Hypotension creates an environment where the cells are starved of glucose and oxygen which denies them the ability to produce ATP (adenosine triphosphate). Without the glucose or the oxygen it would take to convert it to energy, the cells suffer from a lack of energy. Since the cells are no longer really doing anything, there is no activity. Cell structure and purpose vary by the type of cell, but their actions are controlled by a mechanism known as the sodium potassium pump. When the cell is doing something, sodium rushes into the cells and it does something. When the cell is at rest, potassium rushes into the cell. The cell, now dormant tries to work without oxygen and little glucose. The cell tries anaerobic metabolism instead. The waste products of anaerobic metabolism are lactic acid. Switching to an anaerobic metabolism is good for the short term, but quickly gets to a point of diminishing returns given it’s lack of efficiency. Further, the lactic acid accumulates, eventually dropping the pH. Left unresolved, the more acidic water the cells is exposed to eats away at the cell membrane, eventually causing the cell to die. Multiply this by 10,000 and one gets the idea how serious of a problem hypotension can be.