Death Rattle

Q: An eye drop can help minimize the death rattle.

A) True

B) False

Answer: A

Patients in the end-of-life process lose their ability to clear oral secretions. As air moves over secretions that have pooled in the respiratory tract, the resulting turbulence produces noisy ventilation, known as a death rattle. This can be of great psychological distress to the family, though it does not usually affect the patient.

1% Atropine ophthalmic drops given sublingually can help to minimize the death rattle. The onset of action is about 30 minutes, and it can be given every 2 hours PRN.

Other treatments are:

• Scopolamine patch placed behind the ear once every three days
• Benadryl 25-100 mg every 4 to 6 hours PRN 
• Glycopyrrolate- 400 mcg SC every 8 hours PRN

#palliative-care

#end-of life-care

References:

1. McEvoy T. Atropine: Terminal Respiratory Secretions. Hosp Pharm. 2016 Jan;51(1):39-41. doi: 10.1310/hpj5101-39. Epub 2016 Jan 1. PMID: 38745721; PMCID: PMC11089618.

2. Shinjo T, Okada M. Atropine eyedrops for death rattle in a terminal cancer patient. J Palliat Med. 2013 Feb;16(2):212-3. doi: 10.1089/jpm.2011.0537. Epub 2012 Jun 29. PMID: 22747099.

3. Lokker ME, van Zuylen L, van der Rijt CC, van der Heide A. Prevalence, impact, and treatment of death rattle: a systematic review. J Pain Symptom Manage. 2014 Jan;47(1):105-22. doi: 10.1016/j.jpainsymman.2013.03.011. Epub 2013 Jun 18. PMID: 23790419.