Accidental **semaglutide** overdose of **9.6 mg** causes isolated, self-limiting dysesthesia in 50-year-old man

The global rise in obesity has led to widespread use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) like semaglutide. This increased usage has unfortunately coincided with a parallel rise in medication errors and accidental overdoses. While gastrointestinal symptoms are the most commonly reported adverse effects of supratherapeutic exposure, neurologic manifestations remain poorly characterized. This case addresses a gap in understanding these less common, isolated neurologic presentations following high-dose GLP-1 RA exposure.

This case report details a 50-year-old man with obesity who was receiving weekly semaglutide 2.4 mg. Due to a pen-device handling error, he accidentally administered a total dose of 9.6 mg. His clinical course was observed, and laboratory tests were performed 4 days after the accidental exposure to assess for any systemic abnormalities. The primary endpoint was the characterization and resolution of any adverse symptoms.

Two days following the accidental 9.6 mg semaglutide injection, the patient developed generalized burning dysesthesia and marked asthenia. Notably, these symptoms occurred in the complete absence of typical gastrointestinal complaints such as nausea, vomiting, or abdominal pain. Laboratory tests conducted 4 days post-exposure were entirely unremarkable, ruling out common metabolic or systemic complications. The neurologic symptoms gradually improved over time.

Symptoms of generalized burning dysesthesia and marked asthenia resolved completely within 7 days without requiring any specific medical treatment or intervention. Clinical trial data hint at a possible dose-related signal for dysesthesia with high-dose oral semaglutide, but acute parenteral supratherapeutic exposure with isolated neurologic symptoms remains scarcely reported.