Terminal respiratory secretions, commonly known as a “death rattle,” occur when mucous and saliva build up in the patient's throat. As the patient becomes weaker and/or loses consciousness, they can lose the ability to clear their throat or swallow.
Death rattle is a common symptom in the dying phase which is caused by an accumulation of secretions in the upper airway [1]. This accumulation of fluid (mucus) cannot be easily coughed up or swallowed by the patient, often as a result of a diminished consciousness.
The limbs may become cool and perhaps bluish or mottled. Breathing may become irregular. Confusion and sleepiness may occur in the last hours. Secretions in the throat or the relaxing of the throat muscles can lead to noisy breathing, sometimes called the death rattle.
A gurgling sound that comes from the back of the throat of a dying person. It is caused by the build-up of saliva and mucus in the throat and upper airways when the person is too weak to cough.
Terminal respiratory secretions occur as the body's breathing slows. This typically lasts no more than a few hours, but each patient is different and it can continue for as long as 24-48 hours. While the sound is difficult for family members to hear, it does not cause the patient pain or distress.
Death rattle usually becomes audible 24 to 48 hours before death (6,7). Reducing the distress among listeners has been conventionally treated through attempts to reduce or eliminate patient noise.
The rattle you are describing sounds like the'death rattle'. It can subside from time to time.
Agonal breathing or agonal gasps are the last reflexes of the dying brain. They are generally viewed as a sign of death, and can happen after the heart has stopped beating.
Visions and Hallucinations
Visual or auditory hallucinations are often part of the dying experience. The appearance of family members or loved ones who have died is common. These visions are considered normal. The dying may turn their focus to “another world” and talk to people or see things that others do not see.
The death rattle can sound like the person is choking. However, no evidence suggests that the dying person is aware of the sound or experiences any related pain or unease.
Your loved one may seem to be working hard to breathe -- even making a moaning sound. The moaning sound is just the sound of air passing over very relaxed vocal cords. This indicates that the dying process is coming to an end.
Agonal breathing is sometimes confused with a different phenomenon referred to as “death rattle.” Death rattle is more of a gurgling noise caused by mucus or saliva that is caught in the chest as a person is dying. By contrast, agonal breathing is an often brief period of abnormal breathing.
Pulse and heartbeat are irregular or hard to feel or hear. Body temperature drops. Skin on their knees, feet, and hands turns a mottled bluish-purple (often in the last 24 hours) Breathing is interrupted by gasping and slows until it stops entirely.
Atropine, Hyoscine butylbromide, or scopolamine are equally effective for the treatment of death rattle in terminal care.
Terminal restlessness generally occurs in the last few days of life. Around 42 percent of hospice patients experience agitation during their final 48 hours. But even more develop symptoms before then, which may not subside until death.
In the hours before death, most people fade as the blood supply to their body declines further. They sleep a lot, their breathing becomes very irregular, and their skin becomes cool to the touch. Those who do not lose consciousness in the days before death usually do so in the hours before.
They might close their eyes frequently or they might be half-open. Facial muscles may relax and the jaw can drop. Skin can become very pale. Breathing can alternate between loud rasping breaths and quiet breathing.
The term agony, deriving from the Greek ἀγωνία that means “fight”, defines the last moments of the living organism's existence before the encounter with death, and its phenomenology is still to be explored.
While the death rattle sound does not hurt the individual, it can still be painful for loved ones to hear it. Caregivers will often take steps to minimize the sound. However, it should be noted that these treatments only work temporarily and can be more disruptive to the individual as they undergo end-of-life care.
Anticholinergic medication is considered the standard treatment for death rattle. Treatment of death rattle is regarded as an essential intervention in the care of dying patients by specialists in palliative care [8].
Terminal respiratory secretions (or simply terminal secretions), known colloquially as a death rattle, are sounds often produced by someone who is near death as a result of fluids such as saliva and bronchial secretions accumulating in the throat and upper chest.
It is one of the post-mortem signs of death, along with pallor mortis, algor mortis, and rigor mortis. Livor mortis usually sets in 20 to 30 minutes after death and increases in intensity until it becomes fixed at about 12 hours.
As death nears, a person's eyes may stay open, without blinking. There may be long pauses between breaths. You also may notice some of the following skin changes, which occur as blood circulation slows: The skin may become blue and blotchy.
According to a research most hospital deaths occur between 3am to 4am. This is the time in a day when the body tries to prepare for the activities of the next day while the brain tries to dispose some information to give space to the future happenings of the next day.