Subsequently, during the first hospital day, the family informed us that an empty drinking glass, a bottle of potassium cyanide, and a suicide note had been found at the side of the bathtub. The patient was started on sodium thiosulfate to enhance cyanide elimination, which was associated with marked improvement of his acidosis and BP. Retrospective review of the patient’s presentation shows a high venous Po2 (62 mm Hg), access to cyanide (he was a biochemist who owned a small chemical company), facial flushing, bright-red blood, mydriasis, cardiovascular instability, and lactic acidosis, all of which are suggestive of cyanide toxicity. A whole-blood cyanide level measured 18 h after ingestion (approximately nine half-lives) was 1 mg/L. On the second hospital day, following correction of the acidosis and discontinuation of catecholamine support, the patient remained in coma with no corneal, pupillary, oculocephalic, or oculovestibular reflexes. Following a positive apnea test result, he was pronounced brain dead.