Metabolic acidosis (plasma bicarbonate < 15 mmol/L) and hyperlactataemia (lactate > 5 mmol/L), which are common in severe falciparum malaria and are good predictors of fatal outcome, have never been described in vivax severe disease. In a series of children with vivax infection admitted to the ICU, metabolic acidosis is mentioned [92] , however concomitant sepsis is described in this series and specificity for malaria cannot be assumed. If one admits lactic acidosis as a consequence of hypoxia triggered by microvasculature obstruction in falciparum disease, the scarcity of data on the frequency of this phenomenon in vivax disease may simply reflect the less severe obstruction due to less cytoadhesion, as already suggested elsewhere [133, 134] . In the case of hypoglycaemia (blood glucose < 40 mg/dL), the complication has been rarely described elsewhere [123, 135] , and in only two studies in Brazil this finding was reported among children and pregnant women [32, 92] .