The Toxicology Consultation Clinic (TCC) is part of the Clinical Toxicology Consultation Service (CTCS) provided by Changi General Hospital, Singapore (CGH). The CTCS provides 24/7 (24 hours a day, 7 days a week) phone and inpatient consultation service to the hospital. The CTCS is run by trained clinical toxicologists and is supported by CGH’s Accident & Emergency Department.
The Toxicology Consultation Clinic provides outpatient consultation service for patients with toxic exposure. Patients may have symptoms of acute, subacute or chronic poisoning from any chemical exposure / poison including venom from the bite or sting of a venomous animal.
Why should patients be referred to the TCC?
We are exposed to chemical agents daily and are sometimes, inadvertently, exposed to excessive amounts at our workplace, home, through our hobbies, or from the food and supplements we eat. The chemicals accumulate in our body and cause gradual harmful effects that may not be easily detected at first. In the long run, this may lead to disabling conditions such as organ failure (i.e. liver failure or renal failure), cancer and developmental delay / developmental disabilities.
The TCC evaluates patients with possible or confirmed acute or chronic toxic exposure, determines the source of poisoning and manages its effects. The TCC also manages the prolonged / delayed secondary effects and complications that result from chemical exposure.
What services do we offer?
1. Diagnose and assess the severity of poisoning and determine the prognosis of the condition.
2. Determine the probability of the patient’s condition being related to toxic exposure.
3. Determine the source and route of the toxic exposure: environment, food or workplace, etc.
4. Determine the correct samples, blood or urine to collect and the collection methods for the required tests to evaluate the toxic
exposure. Interpret the results obtained.
5. Administer medical management like chelation and other therapies as needed. Make recommendations to decrease further exposure. (The purpose of chelation is to remove heavy metals from the body to treat the most common forms of heavy metal poisoning—lead, arsenic or mercury.)
6. Work closely with Ministry of Manpower’s (MOM) occupational physicians to determine the source of exposure for work-related toxic exposures through worksite visits and environmental monitoring.
7. Provide recommendations on workplace safety measures, such as engineering controls, safety programmes, worksite monitoring and on personal protective equipment.
What cases can be referred to the TCC?
1. Patients experiencing acute or chronic harmful health effects after exposure to chemicals from workplace, food, environment and hobbies, etc.
2. Patients with abnormally high levels of any chemicals detected in their body. The source of exposure may not be obvious.
3. Suspected poisoning as a cause for symptoms after exclusion of other common medical causes (e.g. peripheral neuropathy, developmental delay / disabilities, non-specific psychosomatic problems, infertility issues, etc).
4. Patients who suspect that they have been poisoned by exposure to chemicals either accidentally or deliberately.
Who can refer cases to the TCC?
1. Primary care physicians (i.e. General Practitioners).
2. Hospital specialists including emergency physicians
3. CGH ward staff on behalf of their patients.
4. Ministry of Manpower and any designated factory doctors
What are the harmful effects of some common chronic poisoning?
1. Heavy metals
• Arsenic: skin hyperpigmentation (patches of skin become darker as compared to the surrounding skin), peripheral neuropathy (numbness and pain in your hands and feet), skin and lung cancer
• Mercury: tremors, non-specific psychosomatic complaints, neuropathy (tingling or numbness in certain areas of the body, especially the hands and feet).
• Lead: abdominal colic (intense cramping or colicky pain, which may be accompanied by nausea and vomiting), nephropathy, developmental delay/disabilities, infertility
• Cadmium: nephrotoxicity, osteomalacia (soft bones)
• Manganese: psychiatric disorder, parkinsonism and other extrapyramidal movement disorders
2. Pesticides: neurobehavioral effect, extrapyramidal effects, neuropathy
3. Solvents, benzene and vinyl chloride: risk of cancer and other systemic effects like low blood counts, liver and kidney injury
What are the sources of possible poisoning?
• Environment: this includes buildings, the soil, and the air we breathe
• Workplace: all sorts of chemicals are involved in workplace exposure
• Hobbies: those that involve the use of chemicals (e.g. spray paint, glue etc)
• Food and health supplements that we eat
• Household chemicals and medications
Toxicology Consultation Clinic (TCC) Operation Hours:
Every Friday, 2pm to 5pm, at Specialist Outpatient Clinic (SOC) A, Level 2
To make an appointment, call our Appointment Centre at 6850 3333
or go to our Online Appointment Booking page:
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