The major complications of severe malaria include cerebral malaria, pulmonary edema, acute renal failure, severe anemia, and/or bleeding. Acidosis and hypoglycemia are the most common metabolic complications. Any of these complications can develop rapidly and progress to death within hours or days. In many patients, several of these complications exist together or evolve in rapid succession within a few hours. ... In various studies risk factors for severe malaria and death include age greater than 65 years, female sex (especially when associated with pregnancy), nonimmune status, coexisting medical conditions, no antimalarial prophylaxis, delay in treatment, and severity of the illness at admission (coma, acute renal failure, shock, pulmonary edema, coagulation disorders). In tropical countries with a high transmission of malaria (hyperendemic areas), severe malaria is predominantly a disease of young children (1 month to 5 years of age). In industrialized countries, most life-threatening complications occur in nonimmune travelers returning from endemic areas. Severe malaria accounts for approximately 5% of imported malaria cases (range 1–38%). The case fatality rate in returning travelers with falciparum malaria varies from 0.6% to 3.8%, and for severe malaria it may exceed 20%, even when managed in intensive care units (ICUs).