Using Subcutaneous Hyoscine Butylbromide in A Terminal Patient with Myasthenia Gravis: A Case Report

Management of "death rattle" at the end of life typically involves the use of anticholinergic agents to reduce airway secretions. However, in patients with myasthenia gravis - an autoimmune condition affecting acetylcholine receptors, causing fatigability and weakness of the skeletal muscles - the use of such agents poses a challenge. Anticholinergic agents antagonize the effects of acetylcholinesterase inhibitors, which are critical for treating myasthenia gravis, and may exacerbate symptoms. We report the case of a terminal patient with underlying myasthenia gravis who had concomitant death rattle. A trial of hyoscine butylbromide was effective in treating the death rattle, while the myasthenic symptoms remained quiescent. To our knowledge, this has not been reported previously.