What is a death rattle?

Sometimes, when a loved one is severely ill, you may wonder if you will know some of the signs that death is near. While a loved one’s passing is never easy to consider or see, there are some symptoms that may indicate a person is dying. An example is terminal respiratory secretions, also known as a “death rattle.”

A death rattle is a distinctive sound that a person may make as they are coming to the end of their life and may no longer be able to swallow or cough effectively enough to clear their saliva. While a death rattle can be difficult to hear, it does not usually cause pain or discomfort to the individual.

What are the causes of a death rattle?

A death rattle occurs when a person is in a weakened state, or is in and out of consciousness. They may not be physically strong enough to cough or swallow to clear the secretions from the back of their throat. These secretions include normal saliva and mucus production that people usually swallow and clear without difficulty.

In addition to these factors, a person’s breathing may also change. Their breathing may become irregular, and they may take breaths of varying depths. Sometimes the breathing may be described as “labored,” or appears difficult for the person. When they take a deeper breath, the death rattle sounds may be louder because the deeper, more forceful breath is moving against the secretions in the back of the throat.

What are the symptoms of a death rattle?

A death rattle is a crackling, wet sound that is heard at varying levels with each breath. Sometimes, the sound is soft and moan-like. Other times it’s loud and sounds like snoring or gargling.

These sounds can be distressing to loved ones because it may sound as though the person is “drowning” or choking. However, there is currently no evidence that these noises cause the person any pain or anxiety.

If a person is very close to the end of their life, they may also experience:

  • confusion
  • sleepiness
  • cool or cold extremities
  • irregular breathing
  • skin that appears blue-tinted or mottled

What are the treatments for a death rattle?

No evidence currently suggests that a death rattle is painful, distracting, or distressing to the dying person. However, the sound can be distressing or concerning to family members and loved ones. Healthcare workers can offer some treatments that may minimize the sound. These include:

  • repositioning a person so they are turned to their side with their head slightly elevated (this makes the secretions less likely to stay in the back of the throat)
  • limiting the person’s oral fluid intake
  • giving medicines that can “dry” secretions, such as glycopyrrolate (Robinul), hyoscyamin (Levsin), or atropine
  • providing mouth care, such as using slightly moistened mouth swabs and gently suctioning the mouth only, may also help

However, as a death rattle is often a symptom of the dying process, it may not be possible to eliminate the sound entirely.

Also, deep suctioning of the person’s mouth may clear the secretions temporarily, but can be very disruptive to the person and the sounds are likely to return.

The takeaway

A person survives an average of 23 hours after the onset of a death rattle. At this time, friends and family should try to say their goodbyes to their loved one.

Holding your loved one’s hand, telling them how much they mean to you, and just being there can be important to a person at the end of their life. The death rattle sounds may persist until a person does take their final breaths.