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Cellular ischemia occurs when perfusion (oxygenation of the body and tissues) decreases. Because of the lack of blood flow through the capillaries the metabolism goes from aerobic (with oxygen) to anaerobic (without oxygen) which causes metabolic acidosis. The blood stagnates in the capillaries and lactic acid builds up due to the pre-capillary sphincter relaxing. Also the vasomotor center fails and the carbon dioxide level increases. Because the post-capillary sphincters stay constricted the capillaries are enlarged with fluid. On and on the end result is a drop in cardiac output.

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