Human activities, especially increased nutrient loads that set in motion a cascading chain of events related to eutrophication, accelerate development of hypoxia (lower oxygen concentration) in many areas of the world’s coastal ocean. Climate changes and extreme weather events may modify hypoxia. Organismal and fisheries effects are at the heart of the coastal hypoxia issue, but more subtle regime shifts and trophic interactions are also cause for concern. The chemical milieu associated with declining dissolved oxygen concentrations affects the biogeochemical cycling of oxygen, carbon, nitrogen, phosphorus, silica, trace metals, and sulfide as observed in water column processes, shifts in sediment biogeochemistry, and increases in carbon, nitrogen, and sulfur, as well as shifts in their stable isotopes, in recently accumulated sediments.