A death rattle is noisy breathing that often occurs in someone who is near death.^[1] It is caused by an accumulation of fluids such as saliva and bronchial secretions in the throat and upper airways.^[2] Those who are dying may lose their ability to swallow and may have increased production of bronchial secretions, resulting in such an accumulation.^[3] Usually, two or three days earlier, symptoms of approaching death can be observed, such as saliva accumulating in the throat, difficulty taking even a spoonful of water, shortness of breath, and rapid chest movement. While death rattle is a strong indication that someone is near death,^[2] it can also be produced by other problems that cause interference with the swallowing reflex, such as brain injuries.^[3]

It is sometimes misinterpreted as the sound of the person choking to death or gargling.

Timing

This symptom most commonly appears sometime during the last 24 hours of the person's life, although some people live somewhat longer.^[4]

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.^[1] This may be done through repositioning the person, reducing the volume of IV fluids being given, or giving anticholinergic drugs to reduce secretions.^[4] In hospice and palliative care, drugs such as glycopyrronium, hyoscine hydrobromide (scopolamine) or atropine may be used for their anticholinergic effects to reduce secretions and minimize this effect.^[5]