Hydroxyurea (HU) specifically inhibits class I ribonucleotide reductase (RNR), depleting dNTP pools and leading to replication fork arrest. While HU inhibition of RNR has been recognized for decades, the mechanism by which it leads to cell death remains unknown. To investigate the mechanism of HU-induced cell death we used a systems-level approach to determine the genomic and physiological responses of E. coli to HU treatment. Our results suggest a model by which HU treatment rapidly induces a set of protective responses to manage genomic instability in the majority of the cell population. Continued HU stress activates iron uptake as well as the toxins MazF and RelE whose activity causes the synthesis of incompletely translated proteins and stimulation of the envelope stress response system. These effects alter the properties of one of the cell’s two terminal cytochrome oxidases in the electron transport chain, causing an increase in the production of superoxide. The increased superoxide production from the respiratory chain together with the increased iron uptake fuels the formation of hydroxyl radicals that contribute to HU-induced cell death. This work significantly expands our understanding of HU-mediated cell death and more broadly suggests a pathway whereby replication fork arrest leads to cell death.