The Death Rattle (medically known as Terminal Secretions)

Death rattle is the scary sound a person often makes in the hours or sometimes days before death. It is fluid that accumulates in the lower throat. The person is not swallowing. The saliva and fluid in the lungs, due to lack of normal body processing (the body is shutting down and nothing works right), is accumulating in the lower part of the throat. That fluid is too deep to really be reached by a suction machine although that is the first thing we think of to get rid of it. 
The death rattle is not always present. Those people that have more fluid or are more hydrated as they approach death, are the ones most likely to experience this natural phenomenon.

Human beings tend to be “fix it” personality types and we particularly expect medical professionals to fix any situation. The death rattle is a normal, natural part of the dying process. It is harder on us, the watchers, than on the person who is dying. By the time a person is experiencing a death rattle they are very much removed from their bodies, generally non responsive and are busy in the process of letting go of their bodies. The congestion is part of that letting go.

For the “fix it” personalities a Scopolamine Patch is sometimes effective in reducing the secretions as is Atropine 1% drops. Generally, simply repositioning the person from side to side and keeping them off of their back will help reduce the rattle as much as anything.

What really helps is that we know that what is happening is very much a part of the normal dying process, that nothing bad is happening. It is scary because we are not used to the sound, it sounds uncomfortable and like it shouldn't be happening so we want it to stop. This is our discomfort. This is part of our fear and grief in the experience.

If we understand how the body naturally releases it’s hold on life, fear of the experience for us (the watchers) can be reduced. We can share more comfortably in the gift of being with a loved one who is dying.

Our presence at the bedside, of love, support, and touch, is the comfort that is needed during this last experience of our loved one, not medical intervention.

Something More...  about The Death Rattle (medically known as Terminal Secretions)

So many families are alone in the final day, hours, minutes before their loved one dies even if they are in hospice care. We have a guide for families called The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death.  Our DVD Kit, NEW RULES for End of Life Care is helpful for families to watch as it explains what will happen when death approaches and how best to care for the dying loved one. If you know someone who is approaching death you may want to look at the End of Life Guideline Series.

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My father passed March 1st from congestive heart failure and 2 months and 7 days later mom went from end stage renal failure. When mom passed she was mostly unresponsive for a week but in the last 36 hours her eyes opened most of the way and a few hours before passing she had a white very light foam come from her mouth almost resembling feathers because it was so light. I was beside them both for the end and struggle to understand some things that occurred. But thanks for this outlet.
BK Books replied:
Hi Steve, my parents died within 5 months of each other so I know some of the feelings you are experiencing. About how your mother died; most people die with their eyes partially open. I don’t know why. Maybe it takes energy to keep them closed and energy to hold them open so the natural place is partially open. I don’t know but that is how most people die. About the white, feathery fluid from her mouth, again, so common. I think that is part of the letting go. There is no muscle effect to hold anything in—-pee, poop and stomach or lung fluids just come out when there is no control to hold them in. Hope this adds a bit of clarity for you. Blessings! Barbara


Hello Barbara,
I happened upon your website by mistake and I feel so blessed that I did. I read a lot of your comments from readers and your responses which I found helpful. I lost my brother August 1, 2022 while he was under his daughter’s care in NC. I live in Charleston, SC. This daughter had the other daughter call my neice 8 days after he passed and then my niece called me. I was hysterical as I had always been very close to him. He passed with Alzheimer’s and unfortunately had gotten upset with me and told all of our friends and family that I had taken $300 from him every time I went to see him in Atlanta which was absolutely not true. I think his daughters believed him which was unfortunate as they did not let me know he was sick for months before passing.
The reason I’m writing is because I have no closure and I still grieve my brother terribly. I’m so sad and I’m regularly wanting to pick up the phone to tell him something, hear his deep, loud voice, listen to him tell me a joke for the 10th time. As I sit here and cry, I just want you to know that I’m going to try your advice of writing him a letter and tell him how much I love him, how fun he was, how much I miss him, and how I’ll see him on the other side. Then I’ll tear it up and throw in the wind. Then I’ll pick up the pieces, because I don’t like to litter and I’ll recycle them! God Bless.
BK Books replied:
Jeanette, I’m so sorry you didn’t get to say goodbye to your brother. Yes, do write him a letter. Write all the things you mentioned and be sure to write about the misunderstanding too. Imagine his reaction and respond to what he might say. Also you can burn the letter and scatter the ashes. That way you don’t have to worry about littering. Blessings to you Barbara


Hi Barbara. Your article has helped me a lot as I am very concerned that something bad happened to my father when he was dying. He had advanced dementia, heart failure and asthma and was home after being hospitalized for pneumonia for two weeks. He has been discharged free from pneumonia however his oxygen saturion was lower than before getting ill-it was about 93. I didn’t agree to a feeding tube. My dad was eating less and less (his appetite problems started few months before). In the week before his death he had three brief episodes of dynamically “throwing up” “mucus” that looked like saliva-it was clear, transparent. Apart from that he seemed perfectly OK and calm; there was no wheezing, no death rattle; his breath seemed normal. His oxygen saturation was always above 90. He died after one of such episodes- he “threw up” once and started losing conciousness. I positioned him to help him clear the airways and called the doctor. I am very afraid he had lung congestion/fluid on lungs and I should have reported that to his doctor so that he could have gotten a diuretic (No doctor visited us that week and I was waiting for home hospice admission next week). I am scared that somehow he was suffering from shortness of breath and congested lungs and I missed that as there were no alarming signs like difficulties breathing or restlessness. Is there a possibility he wouldn’t have been suffering even if he had fluid on lungs? (He was receiving heart medicines-besides diuretics- and was nebulised with Berodual and glicocorticosteroids 3 times a day.)
BK Books replied:
Dear Alicja, from what you have described your father died very normally. It was not because of anything you did or didn’t do. With all of his medical abnormalities his body was dying. My guess it was not one thing that he died from but the combination of a body that was no longer functioning. You might write him a letter. Put your thoughts, fears, tears, and everything you would tell him if you could down on paper. Burn the letter and scatter the ashes to the wind Let how well you live your life now be the tribute of your love for him Blessings! Barbara


Hello all of your responses have been so helpful I’ve only found references to purge fluid after death that sounds like what I was wondering. My mom passed 8 days ago on hospice. The last day and a half she was unconscious unmoving just heart beat n breathing but she had yellowish gray secretions begin coming out her mouth and nose large volumes. She had liver cirrhosis and was very swollen from water retention on stomach and legs. Is this the purge found in articles or due to her disease? I’m thankful she didn’t suffer long but this has me thinking she did suffer was she in pain during this? It’s such a hard process seeing your loved one at those end days. Thank u for this area to ask questions
BK Books replied:
Hi Vanessa, when the liver is not doing its job all kinds of bodily fluids accumulate. Fluid builds up in the arms, legs, stomach. Because the fluid is not released it can come out of the skin, nose, mouth. All this fluid just says the body is shutting down. Is this painful? If my body was relatively healthy and functioning and I had edema (fluid) in your legs or hands they would feel “tight”. When the body is dying I’m guessing the body would also feel but I don’t know what. Being non responsive they can’t tell us so we the watchers have to look at body language (agitation, restlessness, verbal sounds) to tell us if a person is uncomfortable. You said your mother was “unmoving” which says to me she was not in pain. My guess; her body felt heavy and oh so tired. It sounds, from what you have described, your mother gently left her body. You might write her a letter. Put all your thoughts, love, tears, everything you would want her to know, on paper. Burn the letter and scatter the ashes to the wind. Let how well you live your life be the gift you give her. You may find my booklet My Friend, I Care helpful as you walk this journey of grief. Blessings! Barbara


My father passed away a couple weeks ago from gastric cancer. I was there when he passed. Shortly after his last breath a lot of blood/liquid came out from his mouth. I say from his mouth but it was so unexpected and happened quickly I’m really not sure. I was so quick to get towels to cover it and clean off my mom who was beside him. Is this normal? I was with my grandma as she passed in hospice and this did not happen with her death so again I was very surprised.
BK Books replied:
Hi Christy, when the body does that it can be so unnerving. It happens every so often. Nothing bad, just surprising. I’m guessing that fluid/blood was in his throat and when all the muscles had no tension in them it came out, just like with pee and poop. Blessings to you. Barbara

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