Prolonged Dysesthesia After Massive Accidental Semaglutide Overdose: A Case Report

The use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has expanded rapidly worldwide for the treatment of obesity, accompanied by a parallel increase in medication errors and accidental overdoses. Gastrointestinal symptoms are the most commonly reported adverse effects in cases of supratherapeutic exposure, whereas neurologic manifestations remain poorly characterized. We report a case of a 50-year-old man with obesity receiving weekly semaglutide 2.4 mg who accidentally administered a total dose of 9.6 mg due to a pen-device handling error. Two days after the injection, he developed generalized burning dysesthesia and marked asthenia in the absence of nausea, vomiting, or abdominal pain. Laboratory tests performed 4 days after exposure were unremarkable. Symptoms gradually improved and resolved completely within 7 days without specific treatment. Clinical trial data suggest a possible dose-related signal for dysesthesia with high-dose oral semaglutide; however, reports of acute parenteral supratherapeutic exposure presenting with isolated neurologic symptoms are scarce. This case suggests that isolated dysesthesia may occur following semaglutide overdose and may follow a benign, self-limited course, a presentation relevant to emergency physicians given the increasing use of GLP-1 RAs.