{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T17:17:12Z","timestamp":1777915032102,"version":"3.51.4"},"reference-count":13,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2020,9,22]],"date-time":"2020-09-22T00:00:00Z","timestamp":1600732800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:p>Death rattle commonly occurs at the end of life and is typically managed with anticholinergic agents. Myasthenia gravis is an autoimmune disorder characterized by fatigability of skeletal muscle, resulting from autoimmune destruction of acetylcholine receptors at the motor endplate. The condition is treated with acetylcholinesterase inhibitors, which potentiate the action of acetylcholine. Agents that antagonize acetylcholine activity (e.g., anticholinergic agents, such as glycopyrrolate) can, therefore, exacerbate myasthenia gravis. We discuss the case of a patient dying with myasthenia gravis that developed problematic \u201cdeath rattle,\u201d and the successful use of glycopyrrolate in treating this symptom.<\/jats:p>","DOI":"10.1089\/jpm.2019.0598","type":"journal-article","created":{"date-parts":[[2020,1,24]],"date-time":"2020-01-24T11:01:50Z","timestamp":1579863710000},"page":"1408-1410","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Glycopyrrolate and the Management of \u201cDeath Rattle\u201d in Patients with Myasthenia Gravis"],"prefix":"10.1177","volume":"23","author":[{"given":"Jonathan","family":"Hindmarsh","sequence":"first","affiliation":[{"name":"Inpatient Unit, Specialist Centre for Palliative Care, St. Benedict's Hospice, Sunderland, United Kingdom."},{"name":"Department of Pharmacy, Sunderland Royal Hospital, Sunderland, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Everett","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Sunderland Royal Hospital, Sunderland, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharlene","family":"Hindmarsh","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Sunderland Royal Hospital, Sunderland, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Lee","sequence":"additional","affiliation":[{"name":"Inpatient Unit, Specialist Centre for Palliative Care, St. Benedict's Hospice, Sunderland, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Pickard","sequence":"additional","affiliation":[{"name":"Inpatient Unit, Specialist Centre for Palliative Care, St. Benedict's Hospice, Sunderland, United Kingdom."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2020,9,22]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"Twycross G Wilcock A Howard P: Palliative Care Formulary 6th ed. 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