Symptomatology of Dying: Death Rattle

There are many symptoms that occur that indicate that we are approaching our death. One of the most well-known is the death rattle. The death rattle is a sound that is produced when air moves through mucus that has accumulated in the throat of a dying person after loss of the cough reflex and loss of the ability to swallow. This is a very common symptom, though it does not always occur prior to death. The death rattle does not cause any discomfort to the patient, however, family members frequently find the sound distrubing.

"Is my mother going to drown to death?" they ask me.

"Cough, Dad, cough!" they demand of their loved one.

"Can you suction her?" they inquire.

We only treat for death rattle if the family is at the bedside and either is disturbed or seems like they may become disturbed by the sound. Some of the treatments used include:

-Atropine opthalmic 1% solution, 1 drop sublingually (under the tongue) every 2 hours
-scopolamine patch placed behind the ear once every three days
-Benadryl 25-100mg every 4 to 6 hours
-suctioning (rarely - to be avoided)

Atropine is used to treat dysrhytmias, insecticide poisoning and decreases secretions by blocking the vagal reflexes. Scopolamine is used to treat nausea from motion sickness, spastic states and decreases secretions also by blocking vagal reflexes. Benadryl is a common over-the-counter medication used to treat allergies, insomnia, motion sickness, non-productive coughs, and Parkinson's disease and causes a dry mouth, which may decrease the sound of the death rattle.

Preventatively, in the hospital setting, we minimize fluids going into the patient so as not to add excessive fluids that may then accumulate in the throat. Repositioning the patient on a routine basis, preferrably every two to three hours, not only prevents bed sores, but it also may minimize the noise.

The death rattle is an indication that death is very near. This type of breathing may gone on for hours, but usually the patient will die within 24 hours of onset.

Suctioning is rarely done, even in a hospital setting where the necessary equipment is readily available. Although at the point when the dying person is experiencing the death rattle, it is unlikely they can register the physical discomfort of suctioning, this treatment option is still considered too invasive. Suctioning with a mouth-focused Yankeur tip cannot go deep enough to reach the mucus creating the noise, so deep throat suctioning is required for suctioning to be effect. The only time suctioning may be appropriate is if the patient is bleeding from or into the mouth. The blood may be suctioned with the smaller suctioning tubes made for tracheostomy patients. However, again, suctioning should be avoided in most cases.

Always reassure families, however distressing the sound of the death rattle may be to them, their loved one is not experiencing any discomfort.