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Death Rattle

What It Is, Causes, Treatment, and More

Author:Ali Syed, PharmD

Editors:Alyssa Haag,Lily Guo,Kelsey LaFayette, DNP, ARNP, FNP-C

Illustrator:Jessica Reynolds, MS

Copyeditor:David G. Walker


What is a death rattle?

Death rattle is a colloquial term also known as terminal respiratory secretions, that describes a distinctive sound that comes from the back of the throat of a dying person. It can be characterized by soft, wet, crackling, moan-like snoring or gurgling sounds. The death rattle occurs when an individual transitions to the final stage of the dying process.

Older adult with a productive, wet cough.

What causes a death rattle?

A death rattle is caused by the buildup of fluids, such as saliva, mucus, and bronchial secretions, in the throat and upper airways. As a dying person becomes weaker, loses consciousness, and experiences slowed breathing, the ability to clear the throat and upper airways by swallowing or coughing become compromised. A wet rattling sound subsequently occurs as an individual attempts to inhale and exhale through the accumulated secretions.  While hearing the death rattle can be distressing for loved ones, it is important to note that it does not cause pain or discomfort for the dying person.

Excited Mo character in scrubs
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What are the signs and symptoms of a death rattle?

Signs and symptoms of a death rattle include increased bronchial secretions, accumulation of saliva in the throat, shortness of breath, and rapid chest movements. Breathing may become irregular and appear labored. Symptoms typically appear anywhere from 24-48 hours before death occurs; however, the timeline can vary. A death rattle may be managed using non-pharmacologic and/or pharmacologic treatments. Members of the healthcare team, caregivers, and/or family members may wipe away any secretions around the mouth and provide mouth care, such as gently moistening the mouth with mouth swabs. It may help to reposition the individual on their side and elevate the head to help fluids drain. Intake of oral fluids may be reduced, and anticholinergic medications (e.g., atropine, glycopyrronium or scopolamine) may be used to decrease the production of secretions. 

What are the most important facts to know about a death rattle?

Death rattle is a colloquial term also known as terminal respiratory secretions, that refers to the distinctive sounds that can come from the back of the throat of a dying person. A death rattle is caused by the buildup of fluids in the throat and upper airways. Signs and symptoms of a death rattle include increased bronchial secretions, accumulation of saliva in the throat, shortness of breath, and rapid chest movements. A death rattle may be managed using non-pharmacological and/or pharmacological treatments.

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Related links

Cholinergic receptors
Hygiene - Oral care: Nursing skills
Palliative & hospice care: Nursing

Resources for research and reference

Crossroads Hospice and Palliative Care. What is a Death Rattle? Accessed June 23, 2023. https://www.crossroadshospice.com/hospice-resources/hospice-caregiver-support/what-is-a-death-rattle/

‌Eldridge L. Understanding the Death Rattle. End of Life Concerns. Accessed June 23, 2023. https://www.verywellhealth.com/what-is-the-death-rattle-2249083

Lokker ME, Zuylen L van, Rijt CCD van der, Heide A van der. Prevalence, impact, and treatment of death rattle: a systematic review. Journal of Pain and Symptom Management. 2014;47(1):105-122. doi:https://doi.org/10.1016/j.jpainsymman.2013.03.011

‌National Cancer Institute. Definition of Death Rattle. NCI Dictionary of Cancer Terms. Accessed June 30, 2023. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/death-rattle

van Esch HJ, Lokker ME, Rietjens J, van Zuylen L, van der Rijt CCD, van der Heide A. Understanding relatives’ experience of death rattle. BMC Psychology. 2020;8(1). doi:https://doi.org/10.1186/s40359-020-00431-3