The 21-day-long hunger strike has started affecting activist Sonam Wangchuk’s health, with his sugar levels and potassium levels dropping. The ketone levels in his urine have also started increasing, indicating that his body is now using his muscles to fuel itself, according to a health bulletin issued by Safdarjung hospital on Saturday evening.The activist was forcibly admitted to hospital at 7.40 am on Saturday morning, “as per the recommendations of the team of doctors looking after him”, according to sources in the Union Health Ministry. The sources underlined that the Delhi High Court had, on July 15, said that doctors could take “whatever medical intervention required” in the interest of Wangchuk’s health.The health bulletin issued by Safdarjung hospital on Saturday evening said Wangchuk was showing signs of dehydration — his own treating physician Dr Satish Lamba too had said the same earlier. Dr Lamba had recorded normal blood pressure, blood sugar, pulse rate, and oxygen levels for Wangchuk on Friday.Also Read | Will continue our vigil here: next to Sonam Wangchuk’s stage, 3 PhD students on protest fastThe Safdarjung hospital bulletin said that a “blood gas analysis” — which is a test to analyse several blood parameters such as pH, oxygen, and carbon dioxide levels — showed that Wangchuk was in “compensated acidosis”.Dr Suranjit Chatterjee, a senior internal medical specialist who is not part of Wangchuk’s medical team, told The Indian Express: “When the body is starved, it starts to utilise its muscles, which leads to the formation of acids. This condition is called acidosis. However, the body is also very good at repairing itself, which is what ‘compensated’ refers to. It means Wangchuk’s body is still fighting.”Dr B K Tripathi, a former head of medicine at Safdarjung hospital, said: “When there is a lack of calories, the body starts utilising its protein reserves. When the proteins are broken down, ketones are produced as a byproduct. This changes the pH of the body, which is linked to several bodily processes, all of which get affected. The body now produces so many ketones that they accumulate and make the blood acidic.”The bulletin from the hospital also stated that Wangchuk’s blood glucose levels were low, which indicates that he doesn’t have enough sugar in his body to use as fuel.Story continues below this adAlso, the urine ketone level had increased from ‘1+’ at the time of admission to hospital to ‘3+’ by the afternoon, indicating that his body is breaking down muscles and using it for generating energy — leading to the formation of ketones.Also Read | Sonam Wangchuk gone, spotlight moves to Abhijeet DipkeThe bulletin from Safdarjung said Wangchuk was continuing to turn down essential medical interventions.“Although intravenous fluids were advised, but the patient has refused all intravenous fluids, oral rehydration fluid, or any other medication. He is being continuously monitored and counselled for treatment,” the hospital said.By evening, an expert from the neighbouring All India Institute of Medical Sciences (AIIMS) had also assessed Wangchuk and concurred with the opinion of the treating team at Safdarjung that Wangchuk needed oral or intravenous fluid and electrolyte therapy.Story continues below this adHowever, the Safdarjung bulletin noted that “Despite repeated counselling by the treating team and the independent expert regarding the urgent need for treatment, the patient has declined… The patient’s family has also not yet provided consent for the recommended medical intervention.”Also Read | Sonam Wangchuk’s hospitalisation, Abhijeet Dipke’s ‘indefinite’ fast: What has happened so farDr Chatterjee said that in a situation of long fasting, the first step is to administer an IV fluid with electrolytes to restore the electrolyte balance in the patient’s body. After that, the person should be given food if they are able to eat, or nutrition through nasal tube.“At present, any damage to his health seems reversible, and can be resolved in a few days. However, the situation is at a stage where things can still go wrong, his organs, and then his brain, can start getting affected, which could lead to him slipping into a coma. These conditions are serious, and may not be reversible,” he said.