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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65 comments

Alicja

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.)
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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

Vanessa

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
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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

Christy

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.
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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

Davor

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
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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

Audrey

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
Audrey
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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. barbara@bkbooks.com. You are in my thoughts. Blessings! Barbara

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