Pal Pills can die in a few ways: 1. * Hitting a enemy, or an enemy attack. 2. * Falling off a cliff. 3. * If Dimentio brings you to Dimension D and you have Pal Pills, they disappear after the battle. 4. * If you go to fast and leave the area they will disappear, they will come if they are near the door or pipe. 5. * They will die if they touch quicksand, there is no way to save them when they touch it. 6. * If you get a Mega Star all the Pal Pills will disappear. 7. * If you complete the chapter with pal pills following you, all the Pal Pills will disappear. 8. * If you use the Return Pipe, the Pal Pills won't go to Flipside or Flopside with you. 9. * Pal pills can't swim. They die in water. 10. * Pal pills die from spikes