668 DISEASES/DISORDERS
THERAPEUTICS
Excision of pancreatic or extrapancreatic neoplasia.
Supportive care for systemic symptoms: appropriate management of diabetes mellitus
(if present).
Nutritional support: high-quality protein supplement; cooked whole eggs or yolks.
Dietary supplementation of zinc 1 mg/kg PO q24h (of elemental zinc), essential fatty
acids, and vitamin E 200–400 IU PO BID.
S-adenosylmethionine 18–22 mg/kg PO q24h.
Silymarin 1–2 mg/kg PO q24h.
Frequent bathing and hydrotherapy to remove crusts and reduce pruritus.
Drugs of Choice
Treatment of secondary bacterial folliculitis and/orMalasseziadermatitis with appro-
priate antimicrobials.
Prednisolone 0.5 mg/kg q24h then taper dosage and discontinue as soon as possible:
temporary relief of pruritus and inflammation; may exacerbate diabetes mellitus; may
aggravate hepatopathy.Octreotide 2–3.2μg/kg by subcutaneous injection BID to QID: somatostatin analog;
nonresected glucagon-producing pancreatic or extrapancreatic neoplasia.
Amino acid infusion: intravenous administration of amino acids to replenish serum
levels from excessive hepatic catabolism:
10% crystalline amino acid solution or 3% amino acid-electrolyte solution:25 mL/kg over 8h
Initial replacement therapy twice weekly until symptoms improve
Maintenance infusions every 7–14 days as indicated by patient response.COMMENTS
Frequent monitoring of serum chemistries needed to monitor for hepatic failure and/
or development of diabetes mellitus.
Repeated treatment for secondary infection.
Poor prognosis;
Worsening prognosis associated with the development of diabetes mellitus
Survival time typically less than 6 months post development of cutaneous lesions
18% survival more than 12 months
Euthanasia most often due to diabetic crisis or hepatic failure.