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Last Days of Life (PDQ®): Supportive care - Patient Information [NCI] - Managing Symptoms

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Also, the doctor may look at drugs the patient is already taking, as some drugs (such as ACE inhibitors for high blood pressure or heart failure) can cause cough.

(See the PDQ summary on Cardiopulmonary Syndromes for more information.)

Death Rattle

Rattle occurs when saliva or other fluids collect in the throat and upper airways.

Rattle occurs when saliva or other fluids build up in the throat and airways in a patient who is too weak to clear the throat. There are two types of rattle. Death rattle is caused by saliva pooling at the back of the throat. The other kind of rattle is caused by fluid in the airways from an infection, a tumor, or excess fluid in body tissues.

Drugs may be given to decrease the amount of saliva in the mouth or to dry the upper airway. Since most patients with rattle are unable to swallow, these drugs are usually given in patches on the skin or by infusion.

Non-drug treatments for rattle include changing the patient's position and giving less fluid.

Raising the head of the bed, propping the patient up with pillows, or turning the patient to either side may help relieve rattle. If the rattle is caused by fluid at the back of the throat, excess fluid may be gently removed from the mouth using a suction tube. If the rattle is caused by fluid in the airways, the fluid is usually not removed by suction. Suctioning causes severe physical and mental stress on the patient.

At the end of life, the body needs less food and fluid. Reducing food and fluids can lessen the excess fluid in the body and greatly relieve rattle.

Death rattle is a sign that death may soon occur.

Death rattle is a sign that death may occur in hours or days. Rattle can be very upsetting for those at the bedside. It does not seem to be painful for the patient.

Delirium

Delirium is common at the end of life.

Delirium is common during the final days of life. Some patients may be confused, nervous, and restless, and have hallucinations (see or hear things not really there). Other patients may be quiet and withdrawn. (See the PDQ summary on Cognitive Disorders and Delirium for more information.)

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