Death rattle

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Death rattle
Other names: Terminal respiratory secretions, terminal secretions[1]
SpecialtyPalliative care
SymptomsNoisy breathing[2]
Usual onsetNear death[2]
CausesAirway secretions, inability to swallow[3][4]
Differential diagnosisChoking, brain injuries, amyotrophic lateral sclerosis (ALS)[4]
TreatmentReassurance, repositioning, decreasing fluids, suctioning the mouth, anticholinergics[3][4]
MedicationScopolamine, hyoscyamine, glycopyrrolate, atropine[4]
Frequency25 to 90%[2]

Death rattle, also known as terminal respiratory secretions, is noisy breathing that frequently occurs in people near death.[2] It may last for hours and generally death occurs within hours to days.[3] Family and caregivers may find it distressing.[2]

It believed to occurs due to saliva and bronchial secretions accumulating in the upper airway together with the loss of the ability to swallow.[3][4] It can be misinterpreted as choking.[4] Similar sounds may occur with brain injuries or amyotrophic lateral sclerosis (ALS).[4]

Management may involved reassuring the family, repositioning the person, decreasing fluid intake, suctioning the mouth, and medications such as anticholinergics.[3][4] Anticholinergics used may include scopolamine butylbromide, hyoscyamine, glycopyrrolate, or atropine.[4][5] Medications may be used preventatively.[5] This is done for the families or caregivers benefits as the sounds do not bother the person affected.[3] It occurs in around 25% to 90% of people.[2]

Signs and symptoms

This symptom most commonly appears sometime during the last 24 hours of the person's life, although some people live somewhat longer.[6]


The dying person is usually unaware of the noisy breathing and is not disturbed by it, but some healthcare providers attempt to minimize the sound for the comfort of family members and caregivers.[7] This may be done through repositioning the person, reducing the volume of IV fluids, or giving anticholinergic drugs to reduce secretions.[6] Options include scopolamine butylbromide, glycopyrronium, hyoscine hydrobromide, and atropine.[8]

See also


  1. Clinical Working Party (December 2010). "Guidelines for the management of respiratory secretions in an imminently dying patient" (PDF). Eastern Metropolitan Region Palliative Care Consortium (Victoria). Archived from the original (PDF) on 3 May 2013. Retrieved 13 April 2014.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 Wee, B.; Hillier, R. (2008). Wee, B. (ed.). "Interventions for noisy breathing in patients near to death". Cochrane Database of Systematic Reviews (1): CD005177. doi:10.1002/14651858.CD005177.pub2. PMC 6478131. PMID 18254072.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 Cobbs, Elizabeth L; et al. "When Death Is Near". MSD Manuals. MSD Manuals (Consumer Version). Archived from the original on 1 November 2022. Retrieved 14 March 2016.
  4. 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 Bickel, Katherine; Arnold, Robert. "# 109 Death Rattle and Oral Secretions, 2nd ed". Fast Facts. End-of-Life/Palliative Education Resource Center. Archived from the original on 1 November 2022. Retrieved 4 September 2017.
  5. 5.0 5.1 Ton, Joey (30 October 2022). "#326 Scary Noises: Reducing death rattle at the end of life". CFPCLearn. Archived from the original on 25 March 2023. Retrieved 14 June 2023.
  6. 6.0 6.1 Ferrell, Betty; Coyle, Nessa; Paice, Judith A. (2015). Oxford Textbook of Palliative Nursing (4th ed.). Oxford University Press. pp. 253–255. ISBN 9780199332342. OCLC 875629996.
  7. "When Death Is Near – Fundamentals – Merck Manuals Consumer Version". Merck Manuals Consumer Version. Archived from the original on 2022-11-01. Retrieved 2017-06-24.
  8. Hipp, B.; Letizia, M. (2009). "Understanding and responding to the death rattle in dying patients". Medsurg Nursing. 18 (1): 17–21, 32, quiz 22. PMID 19331295.

External links