Complications of malaria can occur rapidly, particularly with P falciparum. All forms cause hemolysis and splenomegaly, and splenic rupture may occur. Hypersplenism with subsequent pancytopenia may be seen in advanced cases. Glomerulonephritis, most often in P malariae infections, and nephrotic syndrome may occur. Cerebral malaria, characterized by somnolence, coma, delirium, and seizures, has a mortality rate greater than 20%. Other life-threatening complications associated with P falciparum include noncardiogenic pulmonary edema and metabolic abnormalities, including lactic acidosis and profound hypoglycemia. Blackwater fever is a severe complication seen almost exclusively in P falciparum infections, with massive intravascular hemolysis, jaundice, hemoglobinuria (dark urine), and acute renal failure.