NEW DELHI: The Union health ministry has directed three central government hospitals to conduct twice-daily medical examinations of climate activist Sonam Wangchuk and other participants in the ongoing hunger strike at Jantar Mantar, amid concerns of his “border line condition” and the fact that prolonged fasting could lead to medical emergencies triggered by silent organ failures. In an order issued on Thursday, the ministry designated Dr Ram Manohar Lohia (RML) Hospital as the nodal hospital for any hospitalisation or emergency medical intervention involving the protesters. Medical teams from RML Hospital, VMMC & Safdarjung Hospital and Lady Hardinge Medical College have been asked to conduct health examinations twice a day, at 9 am and 9 pm, while the Centralised Accident & Trauma Services (CATS) has been directed to keep two Advanced Life Support ambulances stationed at the protest site. Hospitals have also been asked to deploy round-the-clock nursing staff and submit daily health status reports. Under the ministry’s roster, the three hospitals will take turns conducting periodic examinations of the protesters on designated days.The ministry said the decision followed a request from Delhi Police and was taken because of a “strong apprehension” that the health condition of the hunger strike participants may deteriorate in the coming days. It said the measures were aimed at preventing any medical emergency and ensuring comprehensive periodic health examinations of all protesters.According to Wangchuk’s medical team, the activist has lost over 9 kg since beginning the fast and currently weighs 56.9 kg. His blood sugar is 80 mg/dL, pulse 72 per minute, and blood pressure 105/61 mmHg while lying down and 101/65 mmHg while sitting. Doctors attending him have said he remains adequately hydrated and mentally alert but is under close medical observation.Refusing to comment on any individual case, Dr Himanshu Sikri, Specialist, Department of Emergency Medicine, Dr Ram Manohar Lohia Hospital, said prolonged fasting beyond two weeks is medically significant even when vital signs appear stable.“Stable blood pressure, pulse or blood sugar should not be mistaken for safety because the body can maintain these through compensatory mechanisms even as serious metabolic changes are occurring. By this stage, muscle protein breakdown, electrolyte depletion and nutritional deficiencies may already have begun, with potential effects on the heart, kidneys, muscles and brain. As fasting continues, the risk of life-threatening complications, including cardiac arrhythmias, kidney injury and irreversible organ dysfunction, increases.“He added that if nutrition is resumed after prolonged fasting, it should be reintroduced gradually under close medical supervision to prevent refeeding syndrome, a potentially fatal complication caused by rapid electrolyte shifts.Explaining the medical effects of prolonged fasting in general, Dr Naval Vikram, Professor, Department of Medicine, AIIMS Delhi, said normal blood pressure or blood sugar alone does not mean a person is out of danger. “The body can maintain apparently normal vital signs despite significant physiological stress. Electrolyte depletion, muscle loss, nutritional deficiencies and even impending cardiac complications may already be developing before abnormalities appear in routine observations,” he said, adding that prolonged fasting can progressively affect the heart, kidneys, muscles and brain, making serial clinical examinations, ECGs, kidney function tests and electrolyte monitoring essential.