Terminal respiratory secretions (or simply terminal secretions),, known colloquially as a death rattle, are sounds often produced by someone who is near death as a result of fluids such as saliva and bronchial secretions accumulating in the throat and upper chest. Those who are dying may lose their ability to swallow and may have increased production of bronchial secretions, resulting in such an accumulation. Usually, two or three days earlier, the symptoms of approaching death can be observed as saliva accumulates in the throat, making it very difficult to take even a spoonful of water. Related symptoms can include

shortness of breath Shortness of breath (SOB), also medically known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing di ...

and rapid chest movement. While death rattle is a strong indication that someone is near death, it can also be produced by other problems that cause interference with the swallowing reflex, such as brain injuries. It is sometimes misinterpreted as the sound of the person

choking Choking, also known as foreign body airway obstruction (FBAO), is a phenomenon that occurs when breathing is impeded by a blockage inside of the respiratory tract. An obstruction that prevents oxygen from entering the lungs results in oxygen depr ...

to death or

gargling Gargling is the act of bubbling liquid in the mouth. It is also the washing of one's mouth and throat with a liquid, such as mouthwash, that is kept in motion by breathing through it with a gurgling sound. A traditional home remedy of gargling ...

Timing

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

Management

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 emotional comfort of family members and caregivers. This may be done through repositioning the person, reducing the volume of IV fluids being given, or giving

anticholinergic Anticholinergics (anticholinergic agents) are substances that block the action of the neurotransmitter called acetylcholine (ACh) at synapses in the central and peripheral nervous system. These agents inhibit the parasympathetic nervous syste ...

drugs to reduce secretions. In hospice and

palliative care Palliative care (derived from the Latin root , or 'to cloak') is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. Wi ...

, drugs such as glycopyrronium, hyoscine hydrobromide (

scopolamine Scopolamine, also known as hyoscine, or Devil's Breath, is a natural or synthetically produced tropane alkaloid and anticholinergic drug that is formally used as a medication for treating motion sickness and postoperative nausea and vomit ...

) or

atropine Atropine is a tropane alkaloid and anticholinergic medication used to treat certain types of nerve agent and pesticide poisonings as well as some types of slow heart rate, and to decrease saliva production during surgery. It is typically giv ...

may be used for their anticholinergic effects to reduce secretions and minimize this effect.

References

External links

Pulmonary Breath Sounds
a page that includes a death rattle sound clip (published by

East Tennessee State University East Tennessee State University (ETSU) is a public research university in Johnson City, Tennessee. Although it is part of the State University and Community College System of Tennessee, the university is governed by an institutional Board of Tr ...

) {{DEFAULTSORT:Death Rattle Death Sounds by type

Timing

Management

See also

References

External links