Poisonings associated with cyanide in over the counter cold medication in Washington State, 1991

In March 1991, four cyanide poisonings were identified in Washington State. Three of these, one nonfatal and two fatal, were directly linked to the consumption of capsules of Sudafed-12 hour cold relief capsules. This article presents the details of these cases including the chronology, causes of death, autopsy and toxicological findings. The fourth case, also fatal, occurred after extensive publicity surrounding the poisonings, and was determined to be a copy-cat case intended to mimic the consumption of tainted Sudafed. The investigation and distinguishing features of this case are also discussed. A further cyanide poisoning occurred in Canada shortly after these incidents and had similar features to the copy-cat case.