Syndrome of Imminent Death

1. Recognition
Early Stage: bed bound; loss of interest and ability to drink/eat; cognitive changes: either hypoactive or hyperactive delirium or increasing sleepiness.

Mid Stage: further decline in mental status--obtunded; "death rattle" -- pooled oral secretions that are not cleared due to loss of swallowing reflex; fever is common.

Late Stage: coma, cool extremities, altered respiratory pattern--either fast or slow, fever is common; death.

2. Time Course: The time to traverse the various stages can be less than 24 hours or up to 10-14 days. Once entered, it is difficult to accurately predict the time course, which may cause considerable family distress, as death seems to "linger".

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