Patients in shock experience decreased delivery of O2 to tissues, decreased activity of the pyruvate dehydrogenase complex, and increased anaerobic metabolism. Excess pyruvate is converted to lactate, which accumulated in tissues and in the blood, causing lactic acidosis. Since O2 is not a reactant or product of the citric acid cycle, why do low levels of O2 decrease the activity of the pyruvate dehydrogenase complex? Solution pyruvate dehydrogenase complex is found in only mitochondria ( we know that mitochondria is the power house of the cell as well as the cell respiration will takes place means what ever the enzymes present in mitochondria they are more active at high oxygen level ) this enzyme requires five cofactors namely TPP,lipoamide,FAD,coenzyme A,and NAD + the conversion of pyruvate to acetyl CoA finished when reduced lipoamide is converted to oxidized lipamide .