GI hemorrhage may be secondary to NSAIDs (stomach), vasculitis of the GI tract (small intestines), or thrombocytopenia The patient may develop massive bleeding leading to shock If bleeding from a gastric ulcer is suspected, endoscopy can confirm the diagnosis Therapy for a bleeding gastric ulcer includes volume replacement, IV proton pump inhibitors, and possibly IV octreotide (1 μg/kg, maximum 100 μg, followed by an infusion of to μg/kg/hr [maximum 50 μg/hr]) (see section on Upper GI bleeding, Chapter 33 Gastrointestinal Bleeding ) If active Bleeding due to vasculitis is suspected, celiac axis angiography or endoscopy with deep intestinal biopsies is required for confirmation GI vasculitis is rare in pediatric lupus, but when it develops, it most commonly occurs in the setting of chronically active disease Cardiac Complications Pericarditis and myocarditis are two of the important cardiac complications of SLE that may require emergency care (see Chapter 86 Cardiac Emergencies ) Pericarditis without significant hemodynamic effects may be managed with NSAIDs or corticosteroids, whereas larger effusions may require drainage Myocarditis is treated with corticosteroids and bed rest with monitoring Raynaud Phenomenon Raynaud phenomenon (RP) is characterized by triphasic color changes of the extremities upon exposure to cold These color changes proceed from cyanosis to blanching due to microcirculatory compromise, and resolve with erythema caused by reactive hyperemia Severe episodes of RP may cause excruciating pain in the extremities, or even digital ulceration and autoamputation Poor circulation impairs wound healing and clearing of infections, so patients with paronychia or digital cellulitis in the setting of acral ischemia may require admission for IV antibiotics Prophylactic techniques to improve digital circulation (avoidance of cold exposure, biofeedback) are the cornerstones of treatment of RP Calcium-channel blockers (e.g., slow-release nifedipine) may decrease the frequency and severity of attacks, whereas oral (e.g., prazosin, sildenafil) and topical (e.g., nitroglycerine) vasodilators or medical or surgical sympathetic blockade may be necessary during severe episodes Cases of impending gangrene may also be treated with prostacyclin analogs Hypertension Hypertension may be a result of effects of SLE on systemic vasculature, the effects of SLE renal involvement, or steroid therapy Headaches Up to 80% of patients with SLE develop headaches, many migrainous, and they may experience acute, incapacitating exacerbations Meningitis (both septic and aseptic), hypertension, and pseudotumor cerebri (idiopathic intracranial hypertension) must be ruled out in children with severe headaches They should have a complete neurologic evaluation and examination of the CSF once a space-occupying lesion has been excluded If the headache is accompanied by blurring or loss of vision, an