Friday, September 17, 2004

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. Statistics collected on its frequency range around the 50% mark. The death rattle rarely causes discomfort to the patient, however, family members frequently find the sound disturbing.

"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 or if the secretions are infectious, in which case the secretions may have a foul odor associated with them. Blood or infectious secretions may be suctioned with the smaller suctioning tubes made for tracheostomy patients. However, again, suctioning should be avoided in most cases, as suctioning almost always causes discomfort while it is being performed.

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

For more information, please see my Death Rattle 201 post.

33 comments:

no milk said...

i'm not sure i find this explanation comforting. :(

Jennynyc said...

Interesting. Tales of the "death rattle" were always a mystery to me.

EJ said...

My mother is a hospice/home healthcare nurse and has always shared stories of her patients. This however is not something she ever shared with me. Thank you.

big seester said...

What are the other symptoms of approaching death? This is fascinating.

Anonymous said...

Thank you for this...I just experienced this on Sunday with the death of my father...

While the explanation isn't comforting, I appreciate your information... God bless you.

Anonymous said...

My mother is at home and has hospice care, but they only come out when I call them. Today, she started making the most awful and loud yelling sound, and was making a kind of gurgling sound in her throat. It seemed like she was trying to clear her throat, but couldn't get it up. When I opened her mouth, she had this really thick, mucous like substance in her throat. The first thing I could think of was to get a mouth swab and try to pull it up from her throat, which I did. I finally got out enough to calm her down. But I am wondering if this is the beginning of the "death rattle". She has been without food or water for 34 days, and has about 1 ounce of urine output in the last 24 hours. She had a stroke initially that caused her to lose her ability to swallow. She is 86 years old and also has Parkinsons and dementia. How close to death is someone when they begin having these symptoms of the thick mucous in the throat and choking sensation? Thanks for any comments.

Anonymous said...

My mother passed away one week ago. The sound of the "death rattle" was the most distressing element of the whole experience. It terrified me and I felt she was drowning. I am an asthmatic and I kept pleading with the carers to sit her upright to facilitate her breathing - as I do for myself during an attack. Reading this article has helped me put the horror of that day into perspective. I now understand that the sound is a natural part of the process of death.

Anonymous said...

my father died one month ago today at a hospice, and the death rattle was there for a few hours before he died. the nurses know the rattle is a sign of death so told us to be prepared. although the rattle is not a nice sound at all id say my father passed away very peacefully.

Thelma's daughter said...

My Mom passed away today. The death rattle was the most disturbing sound I have ever heard. I did not even know what the sound was until a neighbor of my Mom was offering me comforting words after her passing. Definitely the most horrible part of the dying process and not so sure it was not uncomfortable for my Mom as tears were running down her face.
My Mom led a courageous battle with cancer over the last 15 years finally to succomb to the awful disease. Thank you to the people sharing their stories as it has given me some comfort.

Anonymous said...

My aunt died this morning after 22 yrs with MS.
Yesterday was a day i will never forget due to the most frightening 'death rattle' noise i have heard. The nursing staff were very good to her, but did not tell me what this noise was. I wish they had told me!

Chris said...

My husband just passed away from cancer and by far the worst thing was the death rattles. I can not believe it does not bother the patient, my husband was in great distress trying to remove the fluids from his mouth and throat. The nurse did use suction and it did help calm him down.

Anonymous said...

My mother is in the process of dying from terminal Cancer and this rattle has just begun today. I can tell by the nurse's faces and crying when they look at her, the end is very near. For the first time she actually looks peaceful, despite the sound. I see no winces of pain which is a blessing. While the sound is dreadful, there is a peace behind it knowing she will soon be out of all misery and with God.

Anonymous said...

My father passed a week ago and he experienced the death rattle, it lasted only for two days with the second day the sound was very loud and disturbing, he did try to cough it up with no success and I wanted to suction it but the nurse said it wasn't recommended at this point, while she didn't say he was dying her actions said the time was near...I am deeply sadden by the loss of my dad but I am glad he is no longer suffering......

Anonymous said...

I really appreciate this because I am 25 and have never experienced losing a loved one. I had never heard this and hearing it just scared me...this gave me comfort to allow my 93 year old grandmother to rest! THANK YOU!

Anonymous said...

I know this post was meant for humans, but I was looking for some place to find out what had happened to my cat. I found her at the bottom of the stairs with the saliva running from her mouth and she sounded like she was trying to clear her throat. I held her in my arms and within minutes she was gone. I thought it might have been my fault. That she had laid there forever choking on some food and I didn't notice in time. Now in reading this - even though it's human related - I realize she was already on her way to dying when the death rattle started and her death couldn't be prevented. So thank-you for your kind words - they gave me a little peace... RIP Camile - you were loved...and will be missed-

Anonymous said...

These posts have helped me to deal with my 57 year old husbands passing. He lost his speech and most of physical abilities from brain cancer Mar. 1, 2010 and has not been able to communicate with me fully . He passed away on May 13th at home under hospice care. The death rattle was very disturbing and went on for most of the day. The nurse said it probably was more disturbing to me than to him. I felt so helpless to do anything. I am comforted by knowing it likely wasn't painful. This is a memory I would like to erase. I know he is at peace now.

Anonymous said...

1 month ago today my Dad died from congestive heart failure. I sat at his bedside for days witnessing his life slipping away. The death rattle began. I didn't know what was but I did know this wasn't good. A friend of mine later told me what the sound was called.

Dad gave no indication he was experiencing pain or discomfort. The rattle was so loud I had to go into the hallway, I could still hear the sounds several doors away.

One nurse said to me I would never forget that sound. So far she is right, when I hear the sound of percolating water it takes me right to that time and place.

Thank you all for allowing me to share my story - my hope is peace to all who need it.

Anonymous said...

As I sit here listening to the rattle coming from my mom, watching her 2 year battle from lung cancer come to an end, I am both comforted and grateful to know that this is not causing her any discomfort. I equate the sound to those final sips of a milkshake thru a straw. Mom always loved a good chocolate milkshake!

audra said...

my mother dies on March 19 2011. She also was in hospic care. She did have the Death Rattle... It was awful. She lived in an Apt. an the neighbor asked me if we had a coffe pot brewin in her room. Thats how loud it was. Her nurse said there was nothing in there But there was. an I did my best to pull it out....but the more i got out the more came up!

Anonymous said...

please go with god Mom. Allow your suffering to end. You fought brave and hard but please please just go be at peace. I love you...I always will...we will all be okay, I promise you

Anonymous said...

My father was diagnosed with colon cancer 15 months ago. He had surgery to remove the cancerous cells, but it spread to the liver. Chemo followed, however despite there being no sign of cancerous cells in the liver, the cancer spread to his brain. After a craniotomy and radiotherapy, scans revealed he had multiple brain mets and only had 4-12 weeks left.

Just three weeks later, he had a fall and remained unresponsive from thereon. He was moved to a hospice, 24 hours later he developed the most haunting sounds I have ever heard, a gurgling that sounded like he was really struggling to clear his throat or breathe, accompanied by a fairly unpleasant smell, dribbling and mucus streaming from his nose. It was without doubt the most distressing thing I have ever witnessed and although the nurses assured me he wasn't uncomfortable, nor was his brow furrowed and that it was more distessing for us than him- I couldn't help but feel he was uncomfortable, but I do really really hope he wasn't. He also shed a single tear the morning of the day he died- I can only hope this was a natural release of fluids, as he had such low tolerance for pain and was most fearful of dying in pain.

The nurses managed to make him more comfortable, changing him and sitting him more upright. In the afternoon he was breathing more comfortably but by the evening the gurgling returned and his breathing was extremely erratic- as if he was struggling to take even short shallow inhalations. At the time I was ignorant of the symptoms of nearing death, so I left thinking I'd return the next morning.

Just an hour and a half later, with only my mum at his bedside, his breathing apparently became even more erratic and loud (I've since learned this is referred to as Cheyne-Strokes breathing) he then vomited. After the nurses changed him and cleaned him up, it was clear to my mother that he was no longer breathing.

Although the very end was extremely distressing for my mother- the continual "death rattle" is still haunting me, but somehow reading all your accounts is comforting, in that it's a natural part of the dying process- hopefully we're as unaware of it as we were of any distress in being born.

Anonymous said...

My precious mother died on April 7, 2011 13 days after being diagnosed with ovarian cancer. My father died peacefully of cancer 9 years ago. My mother had the death rattle. I had never heard of this before. To me this was the most horrible part of her death. The sounds haunts me, keeps me awake at night. I can't even describe it. To watch someone you love more than your own life have to end this way is just horrible. How do I know that she was not suffering even though she was in a coma. I was not prepared for this in any way shape or form. I don't think those days will ever leave me.

Anonymous said...

Thank you for this explanation. I have been at home the past two months with him on hospice. The last few hrs. Of his life were filled with this sound. It was distrubing and frightening to me. Now thanks to your information I know he was not suffering or in discomfort.

Anonymous said...

Thank you all for your comments. I have heard the death rattle twice in my life once with my mother-in-law where I had to tell my sister-in-law to get them to get her morphine and the second time with my dad. It is a sound you will never forget. The need to try and help them breathe is so heart breaking. I knew what it was when I heard it but never was it explained to me that it didn't cause discomfort. I hope not because my instincts told me he needed more morphine. Hospice did not send anyone until after my 3rd call so I had to pronounce my dad dead but God was merciful he was around his family and not alone. Thanks for sharing its not so scarey now.

Anonymous said...

I am sitting here with my Mamaw right now and she threw up twice last night some black stuff and now her mouth is full of white foam so does this mean its the end?????? and yes she is also doing the groaning growl noise with it.

Anonymous said...

My dearest father died on 3/14/12. He were totally unprepared for the "death rattle" even though he was under Hospice crisis care. This was NEVER explained to us by anyone at the nursing home or from Hospice. It was one of the most excrutiating experiences I have ever gone through. Not only to lose one of the most wonderful people to ever walk this planet, but watching and hearing this was horrible. I just hope that others can be somewhat prepared because we were not.

Anonymous said...

It's 2:00 am. My dad passed away at 3ish yesterday and I am the last to fall asleep. Nobody explained the dying process to me and it was all very sad in every way. I am afraid that the experience will haunt me in my sleep. My dad fought so hard even within a couple hours of his passing. For that I am proud of him and very sad. He tried so hard to win his battle against lung cancer. I will never forget him and as sad and disturbing as it was I was with him on his final breath. Take care of yourselves, we are all ultimately fragile. We only get one chance at this life, please don't take it for granted. Every single person on this planet is just as special as my dad. Be mindfull that other people are just as human as you and respect the beauty and fragility of all living things. Appreciate your loved ones now because they will not always be there for you and you will not always be there for them. Life is by far the most precious thing you can ever own but you can only borrow it. We will all ultimately give it back. It's what you do with it while you have it that matters.

Anonymous said...

My mother, who is passing from small cell lung cancer, has the "death rattle". It is awful to listen to and I take comfort only in knowing that she is not suffering. That being said, she has been "rattling" for 48 straight hours.The rest of us are at wits end. she does appear not to be suffering in any way, but oh it is so awful to listen to. My heart goes out to you all who must hear this.

Anonymous said...

My grandad passed away 8 hours ago. He'd had this death rattle for 12 or so hours before he passed, but was clearly in no pain. He went peacefully. Although distressing for us, it didn't seem to bother him at all.

Anonymous said...

How does anyone know at all...if dying patients, undergoing the death rattle...are discomforted by it or not? Is this just a gentle way to say...do not feel guilty if you asked the doctors to sedate your dying loved one for pain and whatever? What if...the dying person looked terrified when regaining consciousness? She was afraid of drowning all of her life, and when she found she could not cough up the secretions while dying...she looked so scared and she moaned and began to cry a little. She was sedated heavily with narcotics! And, she absolutely did feel discomfort due to the feeling of drowning. Now, am I just nuts or do people really not know about whether patients suffer from this suffocating/drowning known as death rattles? I say sadly, that many must or my own mother would not have shown this. Yes, I suffered watching her struggle for air, but to say that she did *not* suffer is just not true.

Anonymous said...

Answer to if they are in distress or aware during the death rattle, sometimes. My loved one was. She had the rattle for about four or more hours and it was audible, although her breathing pattern had changed hours earlier.

In last minutes she sat up several times, and spoke through the rattle which was loud wheezing times 10. She screamed loud many times, "please help me, help me," and called my name. It was not just reflex, and she struggled to clear the mucus. It was drugs that caused her death, not cancer -- slowly paralyzing all of her body's systems. They increased sleep, suppressed her appetite and digestive system, reflexes and respiratory function.
Not comforting at all no milk. Whether intentional or not the drugs (dilaudid) that she repeatedly asked not to be given was most likely the cause. It was forced on her several days earlier and she had a short episode of the rattle then. When we found out it had been given, we then again asked for morphine only. The day of her death the doctor convinced me that she needed to change her to the dilaudid because she was needing pain meds more often, which was not true.

Anonymous said...

Reading all your storiew has definitely comforted me. My grandmother has this so called death rattle now and has had it for about 12 or more hours. I had to smile after reading someones post about it sounding like that last sip of a milkshake. My grandma would always yell at me for trying to sip up as much soda as I could through that straw. At one point my cousin and I were sitting with her joking about how she was always taking care of everyone before addressing herself. She must have heard us talking about her and how she is so concerned and worried about us that she is afraid to let go. We saw my grandmas face relax and she smiled for a second while deep in her sleep. This tells us she can still hear us. So to anyone experiencing the death of a loved one like we are, I know how it feels to hear that horrible death rattle sound. But keep talking to them. They can hear you and I know it would help them relax and let go. I just pray that my grandma can see that we dont want her to suffer anymore. Grandpa is waiting for her, and I know she will finally get to see him again soon.

Anonymous said...

My father passed away December 21,2012. He was 94 years old. He had dementia and renal cancer. That night a few hours before he died he sat up in bed and told me he was very sick and that he needed to urinate. I helped him stand up to use the plastic urinal that was beside his bed, then I heard the gurgling sounds. I asked him if he wanted to go to the hospital but he softly answered "No". I remember reading somewhere about the death rattle, so I knew he was near death. I asked him if he had pain and he calmly answered "just a little" and he placed his hand on his chest. I put him back to bed,placed another pillow under his head, and helped him turn on his side. Then he sat up and asked me to stay by his bedside. The gurgling sounds started again and went on for about thirty minutes. then they suddenly stopped. My daddy passed away. He went very peacefully. I removed the blankets and found his hands folded across his chest as if he was surrendering. I knew at that moment that my daddy was at peace, which was very comforting to me even though I miss him very much. Thank you I hope this helps someone.