|Other names: Terminal respiratory secretions, terminal secretions|
|Usual onset||Near death|
|Causes||Airway secretions, inability to swallow|
|Differential diagnosis||Choking, brain injuries, amyotrophic lateral sclerosis (ALS)|
|Treatment||Reassurance, repositioning, decreasing fluids, suctioning the mouth, anticholinergics|
|Medication||Scopolamine, hyoscyamine, glycopyrrolate, atropine|
|Frequency||25 to 90%|
Death rattle, also known as terminal respiratory secretions, is noisy breathing that frequently occurs in people near death. It may last for hours and generally death occurs within hours to days. Family and caregivers may find it distressing.
It believed to occurs due to saliva and bronchial secretions accumulating in the upper airway together with the loss of the ability to swallow. It can be misinterpreted as choking. Similar sounds may occur with brain injuries or amyotrophic lateral sclerosis (ALS).
Management may involved reassuring the family, repositioning the person, decreasing fluid intake, suctioning the mouth, and medications such as anticholinergics. Anticholinergics used may include scopolamine butylbromide, hyoscyamine, glycopyrrolate, or atropine. Medications may be used preventatively. This is done for the families or caregivers benefits as the sounds do not bother the person affected. It occurs in around 25% to 90% of people.
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.
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. This may be done through repositioning the person, reducing the volume of IV fluids, or giving anticholinergic drugs to reduce secretions. Options include scopolamine butylbromide, glycopyrronium, hyoscine hydrobromide, and atropine.
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