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with documented symptomatic hypoglycemia occurred in 17.3% and 24.4% of patients when semaglutide 0.5 mg and 1 mg, respectively

Treatment depends on the specific b12 overdose symptoms

Stopping the offending MTX likely led to the resolution of pancytopenia, as did the eventual addition of leucovorin, perhaps, but the vitamin B12 repletion may have improved matters as well