Background: Acute poisoning is an important cause of unnatural death which may occur under a range of different epidemiological, social, cultural and religious implications. Aim: Study the medicolegal pattern of the reported cases of death due to poisoning in the region of Cairo and Giza governorates from 2009 to 2013. Method: Retrospective analysis of reports of all the cases of suspected fatal poisoning received by Zenhom Morgue. Results: Toxic deaths represented 2.5% of all deaths registered in Zenhom Morgue. Males, accidental manner, oral rout were predominant. The most common toxin was carbon monoxide. Conclusion and recommendation: The pattern of toxic deaths in Cairo and Giza governorates varies in both epidemiological and medicolegal aspects, the possibility of under-referral and reporting of these cases to Zenhom Morgue must be taken into account. Competent system of referral of suspected toxic deaths for medicolegal investigation and autopsy must be established.