From the Research
Atropine can be used to manage terminal secretions at a dose of 1-2 drops (0.5-1 mg) of 1% sublingual atropine eye drops every 4-6 hours as needed, as this method has been shown to be effective in reducing terminal respiratory secretions with minimal side effects 1, 2.
Key Points to Consider
- Terminal secretions, also known as "death rattle," occur due to the patient's inability to clear normal respiratory secretions as they become weaker and less conscious near death.
- Atropine works by blocking muscarinic acetylcholine receptors, reducing secretion production in the respiratory tract.
- Side effects may include dry mouth, urinary retention, confusion, and tachycardia, though these are often less concerning in end-of-life care.
- It's essential to start treatment early when secretions first become noticeable, as atropine prevents new secretion formation rather than eliminating existing ones.
- Other anticholinergics like glycopyrrolate or scopolamine may be alternatives if atropine is unavailable or poorly tolerated.
Administration and Dosage
- Sublingual atropine eye drops (1%) can be administered at 1-2 drops (0.5-1 mg) every 4-6 hours when parenteral administration isn't feasible.
- For parenteral administration, a typical dose of 0.4-0.6 mg subcutaneously or intravenously every 4-6 hours as needed can be used.
- Continuous administration via subcutaneous infusion may also be considered, with a dose of 1.2-2.4 mg over 24 hours.
Evidence and Recommendations
- The use of sublingual atropine eye drops has been supported by studies as an effective and reasonable option for managing terminal respiratory secretions 1, 2.
- While other anticholinergics like glycopyrrolate have been studied, atropine remains a commonly used and effective option for this purpose 3, 4, 5.