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VERIFIED CONTENTAuthor: Katarzyna Wieczorek-Szukała, MD, PhD, medical biotechnologist, Medical University of Lodz

"Death rattle" are sounds that can accompany the dying process. These are gurgling sounds caused by a build-up of body fluid in the throat or airways. Does this phenomenon cause the patient additional discomfort? What do we know about the "death rattle"?

The impending death is associated with certain characteristic symptoms associated with the physiological changes of the dying organism. A group of such symptoms may include changes in breathing patterns and unnatural sounds in the throat. This type of gurgling is sometimes called " death rattle ".

What changes accompany the impending death?

In the human body, at some stage of life (most often in late old age or in the terminal phase of the disease), there are changes that indicate the proximity of biological death. As a result of a long-term cancer disease, the destruction of the body takes weeks, and relatives can mentally prepare to say goodbye to their loved one.

The last stages of impending death can be recognized by some characteristic symptoms in the appearance and behavior of the dying person's body. These include, among others:

  • swallowing disorders,
  • unnatural breathing,
  • excessive sighing or rattling,
  • fecal or urinary incontinence,
  • change in skin color or the appearance of spots and bruises,
  • collapsing eyeballs.

However, not only physical symptoms can be a harbinger of the impending agony. Neurological disorders are often accompanied by a number of psychological symptoms:

  • visual or auditory hallucinations,
  • over-stimulation,
  • disturbance of consciousness,
  • increasing sleepiness or coma.

They are a natural consequence of the biochemical and physiological changes taking place in the brain.

Disturbed breathing rhythm as a symptom of agony

An impending death can be recognized, among other things, by a change in pace and manner of breathing. A he althy, regularly breathing person while at rest breathes in once every 3-4 seconds, i.e. at a frequency of 12 to 17breaths per minute.

Adequate oxygen supply is essential for the maintenance of normal vital functions. During the last stages of human life, the so-called agonal breathing, which involves short, infrequent breaths (only a few breaths per minute). This type of irregular breathing pattern can occur directly, for example during:

  • cardiac arrest,
  • stroke,
  • poisoning.

One of the variants of agonal breathing is the so-called Cheyne-Stokes breath, where after several seconds of apnea there is a series of short, slower and shallower breaths.

Agonal breathing can last for many hours, and will often be accompanied by other acoustic effects, such as:

  • moaning,
  • snort,
  • whistling.

Death rattle - what is it?

The altered breathing rhythm accompanying the agony must not be confused with dyspnea or even hyperventilation accompanying severe stress. Agonal breathing is sometimes equated with the disturbing, gurgling sound emanating from the throat and larynx of a dying person - the so-called ratchet of death.

These concepts are divergent, although there is no doubt that the pathological pattern of breathing may occur first and will underlie throat dysfunction and fluid circulation. The "death rattle" is primarily caused by an excessive build-up of saliva in the upper throat and respiratory tract.

A dying person does not cough or swallow properly, therefore the air flowing through the respiratory tract may cause sounds similar to rattling, clicking or snorting.

This type of symptom does not have to be very loud, but in combination with other symptoms of agony, it often additionally indicates imminent death. Contrary to appearances, the "death rattle" does not make it difficult for the dying person to breathe, and the air naturally enters the lungs.

In some cases, the attending physician may recommend intravenous relaxants. Relief can also bring a change in the patient's body position - incl. on the side - which, like during attacks of wet coughing - helps to drain the secretions.

The sounds that appear next to the "death rattle" should not be treated as an indicator of the proximity of death.

The duration of the symptoms accompanying the end stage of death is an individual matter for the individual. Undoubtedly, however, the set of symptoms indicates a worsening condition of the patient and heralds the imminent death.

There is no doubt that loved ones are never able toprepare for the loss of a loved one. If the unpleasant awareness of the end of life is also accompanied by disturbing and moving noises, the feeling of loss and helplessness is all the more overwhelming. However, it is comforting that the "death rattle", although its symptoms may cause consternation, does not deepen the patient's suffering.

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