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The Death Rattle

Recognizing and Treating End-Stage Wet Respirations

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Updated January 21, 2010

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

End-stage wet respirations, most commonly referred to as the death rattle, may occur at the very end of life when a patient is going through the dying process. The death rattle is a symptom that is very distressing to family, friends, and loved ones of a dying patient, even if it's not necessarily distressing to the patient himself. If you are caring for a dying loved one, it's important that you are able to recognize the death rattle, understand why it occurs, and know some practical tips to help treat it.

What is the Death Rattle?

End-stage wet respirations (death rattles) occur when secretions build up in the throat and airway. These secretions are perfectly normal and consist of saliva, mucous, and any other liquids that are introduced into the patient's mouth (wet sponges, medications, etc).

Normally, a healthy person is able to clear their throat and swallow or spit any excess secretions. At the end of life, however, a person may become too weak to clear their throat and swallow their secretions. Altered levels of consciousness -- for example, if the patient is lethargic or comatose -- may also impair a patient's ability to clear their airway. In turn, secretions build up and cause a loud, rattling sound when air passes through the airway.

Comfort Concerns

If your loved one has the death rattle, you might be concerned about their level of comfort. While there is no way to know for sure how wet respirations affect a patient's comfort when they are unconscious, it's typically accepted that the impact of the death rattle on a patient's comfort is minimal. It is likely more distressing to the family and loved ones to hear the death rattle than it is to the patient experiencing it.

Tips to Treat the Death Rattle

If your loved one experiences end-stage wet respirations, there are some practical things you can do to minimize or eliminate it:

  • Try changing the patient's position. Sometimes turning a person from their back to their side will be enough to clear excess secretions from the airway. You can also try raising the head of the bed to promote drainage.

  • Limit the amount of liquid being introduced into the mouth. You will undoubtedly want to keep your loved one's lips and oral mucosa moist with wet sponges, but you can minimize the amount of water that will drain down your loved one's throat by gently squeezing excess water from the sponge before you moisten their mouth.

  • Give anti-cholinergic medication as ordered by your physician. Anti-cholinergics, such as atropine or scopolamine, dry up excess secretions, which can help clear up the death rattle.

As with any new symptom, always notify your hospice agency or attending physician to get further advice and instructions.

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