What is the Death Rattle?

How to Recognize and Treat End-Stage Wet Respirations

Elderly man in hospital bed
What causes a "death rattle" and how can it be treated?. Photo © Ugurhan Betin/Getty Images

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

What is the Death Rattle?

End-stage wet respirations, known as death rattles, occur when secretions build up in the patient's throat and airway. These secretions are perfectly normal and consist of saliva, mucous and/or any other liquids introduced into the patient's mouth via wet sponges to moisten his or her mouth, liquids taken with medications, etc.

Normally, a healthy person can clear his or her own throat and swallow or spit out any excess secretions. At the end of life, however, a patient might become too weak to clear his or her throat and swallow these secretions. Altered levels of consciousness, such as when a patient is lethargic or comatose, for example, can also impair a patient's ability to clear his or her airway. Thus, the patient's secretions build up and cause a loud, rattling sound when air passes through the airway.

Comfort Concerns for Caregivers

If your loved one exhibits the death rattle, you might feel concerned about his or her level of comfort.

While there is no way to know for certain how wet respirations affect a patient's comfort while he or she is unconscious, it is generally 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, here 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 prove effective enough to help clear excess secretions from his or her airway. You can also try elevating his or her head by raising the head of the bed to help promote adequate drainage of these excess secretions.
  • Limit the amount of liquid you introduce into the patient's mouth. While you will undoubtedly want to keep your loved one's lips and oral mucosa moist by using wet sponges, you can minimize the amount of water that will drain down your loved one's throat by gently squeezing the excess water from the sponge before you moisten his or her lips/mouth.
  • Give anti-cholinergic medication, as ordered by your physician. Anti-cholinergics, such as atropine or scopolamine, help dry up excess secretions, which can help clear up the death rattle.

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

    Edited and updated by Chris Raymond.

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