title: Anticholinergic agents for the treatment of "death rattle" in patients with myasthenia gravis.
abstract: Difficulty clearing upper airway secretions (death rattle) is a frequent problem at the end of life. Treatment often includes the use of anticholinergic drugs. Myasthenia gravis is a disease characterized by muscle weakness and fatigue caused by an immune-mediated deficiency of acetylcholine receptors at the neuromuscular junction, and it is treated with anticholinesterase agents. We report the case of a patient dying of myasthenia gravis who had problems with the "death rattle" and who presented a dilemma as to whether the use of anticholinergics would be helpful or would cause deterioration of her myasthenia. This is accompanied by a review of the relevant literature.
authors.affiliation: Department of Internal Medicine, Division of Hematology, Oncology, and Blood & Marrow Transplantation, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242, USA.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Spiess
authors.forename: Shane D
authors.initials: SD
authors.lastname: Scott
mesh_terms: D000368:Aged; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D009157:Myasthenia Gravis / Q000150:complications* / Q000188:drug therapy*; D012135:Respiratory Sounds / Q000187:drug effects*; D012601:Scopolamine / Q000627:therapeutic use; D013727:Terminal Care
chemical_list: D018680:Cholinergic Antagonists; D018727:Muscarinic Antagonists; D012601:Scopolamine