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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Hi Barbara, thank you for all the knowledge and support you give us, My mother died two weeks ago at home and she had a death rattle but on the second day it turn to something brown,almost black , she she was not conscious, she was in a coma for 3 days, it took that long until she left the body, I’m just interested to know in what is that the black-brown substance that appeared on her mouth
BK Books replied:
Hi Davor, the brownish-black could be old blood coming from who knows where, mouth, stomach, lungs. It is not uncommon. I have seen it frequently, all part of the labor of dying. Blessings to you. Barbara


Hi Barbara, thank you for this important information. I have a question I have wondered about. My 5-year-old died at home, of brain cancer. Fortunately—and unfortunately for us— our hospice didn’t have any experience with kids, who seemed to die very differently than adults. At one point, we were told she had hours. She lived four more weeks. She had the death rattle near in her last few days. Nothing came out of her mouth, but she had such strong secretions, that we had one traumatic moment where I thought she would suffocate on them. She was conscious. I spoke to hospice on the phone, as well as the children’s hospital, and they were surprised to hear of this kind of difficulty. Another cancer mom advised me to ask for a suction machine. I did, and it sucked out thick mucus. It looked like yellow snot—nose or mouth. I can’t remember if it came out of one more than another. Someone postulated that perhaps she had gotten sick with a cold. Is that probably the case? Or were those secretions because of her impending death? I understand it’s hard to say—I’m just wondering if terminal secretions could manifest as thick mucus like that. Our hospice was confused by it, and that is why I am wondering.
Thank you so much
BK Books replied:
Hi Audrey, in regards to your question about thick mucus at end of life: I also do not have much expereince with children at the time of death. I can count on one hand the times I worked with children but here is what I think. Our body is programed to die, young or old, it is the body that begins the process, months before death arrives changes begin. The key is to know that nothing works in the normal way any more. The body is a battery losing its charge, is shutting down. With that in mind then anything we consider abnormal, anything we think is out of the ordinary, is possible. About hospice telling you hours and then your child living another 4 weeks: sometimes we get to death’s door, we stop and are just not ready, there is still something to learn or there is something someone else still has to learn, and we pull back, (for a limited time). What a gift you all had, an extra month with your child. About the mucus, it saddens me to hear that another mother had to suggest a suction machine and not those that were suppose to have the knoweldge and where with all to help (also why wasn’t hospice there, in your home, helping you?) back to mucus. I doubt it was a cold. Mucus comes in many forms as death approaches depending on hydration, dehydration, disease process, positioning. Mucus is very much a part of the dying process. I see nothing out of the ordinary in your discription. I hope this gives you a bit of understanding. If it just brought more questions please let me know and I’ll try to address them. You are in my thoughts. Blessings! Barbara

barbara karnes

Dear Karthik, I’m so sorry. From your description it sounds like your uncle is very close to death. My blessings are with you and your family during this challenging time. Barbara

Karthik keshetyy

My uncle is suffering with glioblastoma from last 13 months .
From yesterday he is suffering sound from body it’s very difficult sound
He is not responding for any kind of moments we do .

barbara karnes

Hi Diane, for some of us our labor to leave our body is more difficult than for others. Your father is having a hard labor. I view the suctioning as a comfort measure. Telling me that he has cancer of the throat gives the reason for all the discharge through his tracheostomy. I wonder how much fluid and nourishment he is receiving along with his pain meds through his feeding tube? Fluids will increase the secretions and lung congestion. At this point all he really needs is the pain medicine. Nourishment and fluids will actually cause more discomfort than comfort. If I can be of further help use my personal email My blessings to you, your father and your family. Barbara

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