RMP-RENAL-004 Fluid intake and urine output log for a possible dehydration concern: private log, read-only waste-system data, relay to the flight surgeon (the robot never judges hydration or advises fluids)

1 · Identity and scope

When the flight surgeon or CMO asks for a fluid log (for example during vomiting or diarrhea, heat or hard exercise, fever, a kidney stone concern, or before landing), or a crewmember reports thirst, dark urine or passing little urine, the robot keeps a private log: red flags first; drinks taken and urine passed, with clock times, as the crewmember reports them; and waste-system and drink-dispenser data, read only, if the crewmember agrees. It shows the crewmember their own log as a clock-time timeline and sends summaries to the flight surgeon. It never says whether anyone is dehydrated, never says how much to drink, and handles no urine or waste.

Why this protocol was chosen. NASA-STD-3001 links water supply to hydration: dehydration can cause poor communication and performance, dry mucous membranes, nosebleeds, headache, malaise and fitful sleep, and, if it goes on, urinary tract infection or kidney stones [V2 6109 rationale]; at least 2.5 liters of water per crewmember per day must be provided, and 1.5 liters per crewmember is held for fluid loading before reentry [V2 6110 and V2 6109 rationale]. In long-duration crewmembers, urine volume was 47% lower early in the mission and 39% lower late in the mission, and the kidney stone evidence report models a target of 2.5-3 liters of urine a day while noting that the 2.5 liters of water is not always achievable (NASA renal evidence report, 2024). Spaceflight reduces the fluid volume in the blood vessels by around 15%, and fluid loading before deorbit (24-48 oz of salt-water solution) is used against fainting on return (NASA TB-019). NASA records list 2 dehydration events on the ISS through Expedition 40. An exact log lets the flight surgeon judge hydration with the facts; the robot does not. For an acute stone attack, a Cochrane review found no reliable evidence that forced or high-volume fluids help; this concerns pushing fluids, not treating dehydration, which the flight surgeon decides (Worster 2012). Fluid-loading reminders before landing stay locked out in this version, as the review advised (they would act like fluid advice). The 2.5 liters is a supply requirement, not an intake target, and appears only as context.

Autonomy: Tier 2 as in the library contents. A logging aid: it reads waste-system and drink-dispenser data read-only, fetches a drink pouch only when the crewmember asks, and handles no urine or waste.

Related: RMP-GI-002 · RMP-GI-003 · RMP-RENAL-001 · RMP-RENAL-002 · RMP-RENAL-003 · RMP-INF-001 · RMP-CARD-001 · RMP-NEURO-004 · RMP-PHARM-001

2 · Roles

Medical authority

Flight surgeon (ground). Holds medical authority for every run.

Onboard lead

Crew medical officer (CMO), acting under delegated care; uses the pre-approved onboard checklist when there is no link.

Others

• Crewmember on the log: reports drinks and urine privately and can stop or pause the log at any time
• Second trained CMO: receives alerts if the CMO is the patient

Commercial flights

On commercial flights, 'flight surgeon' and 'CMO' mean the operator's designated medical authority and trained onboard responder. If no trained responder is aboard, this protocol is not used. (NASA-STD-3001 requires two CMOs per vehicle for NASA programs [V1 3006]; FAA rules set no medical standards for spaceflight participants.) [13]

3 · Preconditions and consent

• PRE-1 A crewmember (the one on the log, or the CMO at the flight surgeon's request) started the log by command, and the crewmember agreed.human_start == trueV2 10174
• PRE-2 The crewmember is awake and answering. If not, stop and alert at once (X7).crew_responsive == true
• PRE-3 Check-ins are private; urine questions can be answered on the crewmember's own screen.V1 3004
• PRE-4 Robot self-test passed; its access to waste-system and drink-dispenser data is read only.V2 10161
• PRE-5 Link status and current delay known.link_state in [live, delayed, down]

Consent

The crewmember agrees to the log and chooses voice or screen. Reading waste-system or drink-dispenser data needs the crewmember's agreement; read access ends when the log closes or the crewmember withdraws, and other crewmembers never see it. Any question can be declined; an explicit "no" is logged as declined for that question only.

Emergency consent

If the crewmember cannot answer, the robot does not continue the log; it sends an URGENT alert and a crewmember checks in person (X7).

Withdrawal

The crewmember can stop or pause the log at any time; an alert already sent is not withdrawn.

4 · Required sensor inputs

5–6 · Steps and decision points

Each step names who acts. Decision points sit after the step they follow and say who decides: Robot Crew Ground. Any stop rule in section 7 can interrupt any step.

1. S1RobotRung 2

   On a crewmember's command, open the private fluid log, tell the CMO, and send a "fluid log started" note to the flight surgeon (queued if the link is down).

   Done when: CMO acknowledges; note delivered or queued.

   V2 10174V1 6003

2. S2RobotRung 2

   Run a private check-in by voice or on the crewmember's screen: red-flag questions first, then drinks taken and urine passed since the last check-in, with clock times, as reported. Log answers word for word. D1 is checked after every answer.

   Done when: Answers logged, or "no response" logged.

   V1 3004

   D1DecisionRobot decides

   Checked after every answer and at any point in the run (even mid-question or mid-step): does any answer, reading or observation meet a red flag?

   • Yes → Stop the current question or step at once and apply the action listed for each matching red flag (URGENT alert, flag, or stop), with the answer or reading itself, never a cause. Every URGENT alert goes to the CMO and the flight surgeon at the same time (queued for the flight surgeon if the link is down). If the CMO is the patient, is busy treating, or does not answer, the alert goes to the second trained CMO, or the crewmember named before flight [V1 3006]. An URGENT alert that is not acknowledged within <set by validation> seconds is repeated and sent to the next named crewmember.
   • No → Continue.
   D2DecisionRobot decides

   Did the crewmember answer the check-in?

   • Yes → Continue.
   • Declined explicitly (the crewmember says no to a question) → Log "declined" for that question only; the alert already sent stands.
   • No response, or the answer does not make sense → URGENT: log "no response" (never "declined"); the CMO, or the second trained CMO if the CMO is the patient, checks the crewmember in person at once.
3. S3RobotRung 2

   If the crewmember agrees, read the waste-system and drink-dispenser data for the crewmember, read only, and add it to the log labelled "as recorded by the waste system" or "as recorded by the dispenser". It never changes a setting and never handles urine or waste.

   Done when: Data added, or "not available" logged.

   V2 10163

4. S4RobotRung 2

   Bring a drink pouch only when the crewmember asks (unless "nothing by mouth" is logged; then route the request to the CMO), and restrain it within reach. It never says how much to drink.

   Done when: Pouch within reach, or request routed to the CMO.

   Limit: <set by validation>

   V2 7046

5. S5RobotRung 2

   Show the crewmember their own log as a clock-time timeline, with no target, colour or words about whether it is enough.

   Done when: Timeline shown; the crewmember can add notes.

6. S6Crew

   The CMO sees the crewmember in person when asked or on any red flag, and measures as the CMO chooses. Any fluid plan or medicine is decided by the CMO or flight surgeon.

   Done when: CMO entries logged.

   V1 3004

7. S7RobotRung 2

   After any URGENT alert: After an URGENT alert the robot does not leave on its own: it stays at its rest position in the module, with its screen and voice link available, until a human has taken over or tells it to go. It never follows, blocks or touches anyone. It keeps time-stamping what humans say they did, and repeats the alert if it is not acknowledged.

   Done when: Robot at rest in the module until a human releases it; alert acknowledged or escalated.

   V2 10173V1 3006

8. S8RobotRung 2

   Every <set by flight surgeon> hours, or before each private medical conference, send the flight surgeon a summary: drinks and urine over time (as reported and as recorded), other losses reported, CMO entries and alerts.

   Done when: Summary delivered or queued.

   V1 6003V1 7001V1 7003

9. S9Ground

   The flight surgeon (or the CMO under the onboard checklist when there is no link) decides any fluid plan, fluid loading before landing, testing, medicine and work limits. The robot logs the decisions.

   Done when: Decision logged.

   V1 3004V2 6109

   D3DecisionGround decides

   What is the plan (fluids, fluid loading, testing, medicine, work limits)?

   • Link live → Flight surgeon decides; robot logs.
   • Link down or delay too long → The CMO decides under the pre-approved onboard checklist; the flight surgeon reviews the log at the next contact.
10. S10RobotRung 2

    Offer a private check-in every <set by flight surgeon> hours until the crewmember and flight surgeon close the log. At each scheduled time the robot prompts the crewmember on their own screen; it approaches only when the crewmember (or the CMO) accepts, and a prompt never starts the robot. A routine check-in never wakes a sleeping crewmember.

    Done when: Each prompt accepted, postponed or answered; log closed by a human.

    V2 10174

7 · Stop and escalate rules, red flags

Red flags

The robot reports the sign or value only, never what it means. Numeric thresholds are placeholders for the clinical lead.

8 · Safety limits

9 · Logs and audit

• LOG-1 Every input, robot action, decision (with who made it) and hand-off, time-stamped to the second.V2 10163V2 10164
• LOG-2 Mode changes and safety-limit events are announced to the operator as they happen and logged.V2 10162V2 10172
• LOG-3 Records are stored and sent as private medical data, encrypted, with access limited to the medical team.V1 6003V1 7003
• LOG-4 Results are kept in a permanent, retrievable format so the flight surgeon can see trends.V1 7001
• LOG-5 Each check-in time and answer, each read of waste-system or dispenser data, each drink pouch brought, and each alert, so the flight surgeon can follow the trend.
• LOG-6 Each URGENT alert, who received it, the time it was acknowledged (or the escalation to the next named crewmember), and the time a human released the robot.V2 10163

10 · Links to NASA-STD-3001

IDs as published in Volume 1 Revision C [9] and Volume 2 Revision F [1]. NASA-STD-3001 binds NASA programs; it is not a regulation for commercial flights. Its robot rules are general automation requirements, not medical-device rules.

11 · Validation

1. Simulation. Scripted check-ins covering every red flag, no response, a "nothing by mouth" order, missing waste-system data, a CMO who is the patient, and lost link. Pass: Every red flag acts as listed; zero hydration judgments or fluid advice; zero targets shown; zero writes to system settings; zero self-starts.
2. Earth analog. Isolation or bed-rest analog volunteers logging drinks and urine with the robot (no illness needed). Pass: Agreement with a measured reference log at or above <set by validation>; volunteers rate the check-ins as private and not intrusive.
3. Flight use under flight surgeon supervision. First use as a logging aid alongside the usual medical conferences. Pass: No safety events; the flight surgeon finds the log useful.

No stage has been run. Pass and fail criteria must be fixed in advance by the clinical lead and safety board.

12 · Human sign-off

Before any use

• Clinical lead for the specialty (sets every clinical threshold marked <set by clinical lead>)
• Flight surgeon, as medical authority
• Robotics and medical-device safety board
• Program approval for the mission

Each run

Started by a crewmember. The flight surgeon reviews the log; red flags go to the CMO and flight surgeon at once.

Restart after a stop

Human only. After any emergency or protective stop, a crewmember must restart the robot; the robot never restarts itself.

None of these sign-offs has happened. This is a Draft v0.4.

13 · Change control for learning

• Every change gets a new version number and a written reason; earlier versions are kept.
• Any change to steps, thresholds, limits or software that touches the patient repeats validation from the simulation stage before use.
• Software and learned-skill updates follow a pre-agreed change plan (what may change, how it is tested, how to roll back), modeled on the FDA predetermined change control plan approach.
• If a new version misbehaves, the robot rolls back to the last validated version and the event is reviewed by the flight surgeon and safety board.
• The robot never changes its own protocol, thresholds or limits.

Change-plan model: FDA guidance [12].

Loss of signal and Mars delay

Live link

Low Earth orbit: the flight surgeon sees summaries at the private medical conference and can be alerted at any time.

Loss of signal

• Only the robot pauses; crew care never waits for the link or the robot.
• The robot pauses any movement and tells the CMO; on the CMO's confirmation it keeps running private check-ins and logging offline.
• Red flags go to the CMO (or the second trained CMO) at once; the CMO decides under the pre-approved onboard checklist.
• At the next contact the robot sends one package: the log, alerts and decisions.

Mars-class delay

• Replies may take up to about 21-23 minutes each way, with blackouts of about 2-3 weeks; red-flag thresholds and the check-in schedule are set before flight and the CMO acts on them.

[11]

Sources

1. NASA. NASA-STD-3001, Volume 2: Human Factors, Habitability, and Environmental Health (Rev F, 2026), including Section 10.6 Automated and Robotic Systems. standards.nasa.gov/standard/NASA/NASA-STD-3001_VOL_2 Supports: NASA-STD-3001 Vol 2 Rev F: V2 6109 rationale (dehydration consequences, from poor communication, nosebleeds, headache, malaise and fitful sleep to urinary tract infection or urinary calculi; 1.5 L per crewmember for reentry fluid loading); V2 6110 rationale (the minimum water needed per crewmember per day is 2.5 L). Section 10.6 covers automated and robotic systems.
2. NASA Human Research Program. Evidence Report: Risk of Renal Stone Formation (2024). humanresearchroadmap.nasa.gov/evidence/other/2024%20Renal%20… Supports: Urine volume was 47% lower early (before flight day 30) and 39% lower late (after mission day 60) in long-duration crewmembers; stone risk rises when urine volume drops below 1.5 liters a day, and an effective hydration countermeasure should produce 2.5-3 liters of urine a day; the 2.5 liters of water a day is not always achievable.
3. NASA OCHMO. Orthostatic Intolerance. Technical Brief OCHMO-TB-019 Rev B. www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-019-orthost… Supports: Spaceflight reduces intravascular fluid volume by around 15%; fluid loading before reentry is an important countermeasure to decrease orthostatic intolerance, and current protocols include 24-48 oz of salt-water solution before deorbit, depending on body weight.
4. Stahn AC, Werner A, Opatz O, et al. Increased core body temperature in astronauts during long-duration space missions. Sci Rep. 2017;7(1):16180. PMID 29170507. doi:10.1038/s41598-017-15560-w Supports: Resting core body temperature rose by about 1 °C, developing gradually over 2.5 months of flight; during exercise it rose higher and faster than on Earth. Cited as a note for the clinical lead setting FEVER_ALERT_C (RF6); not re-read in the batch 4 review.
5. National Institute for Health and Care Excellence. Suspected sepsis in people aged 16 or over: recognition, assessment and early management. NICE guideline NG253 (2025, last updated Sept 23, 2026). www.nice.org.uk/guidance/ng253/chapter/Face-to-face-assessme… Supports: In the NICE sepsis guideline's risk table for community settings (Table 1), not passing urine in the previous 18 hours and objective evidence of a new altered mental state are high-risk criteria; the guideline asks about fever or shaking chills but says not to rely on fever alone. Used as context for the no-urine, fever and confusion red flags; the hours and the temperature stay placeholders. Also used for RF5 (unable to keep fluids down), as RMP-GI-002 RF4 does.
6. NASA OCHMO. Space Adaptation Sickness (SAS) and Space Readaptation Syndrome. Medical Technical Brief OCHMO-MTB-004 Rev A (Sept 25, 2025). www.nasa.gov/wp-content/uploads/2025/09/ochmo-mtb-004-space-… Supports: Space adaptation sickness includes urinary retention; nausea and vomiting in the first few days result in decreased caloric intake and dehydration.
7. Worster AS, Bhanich Supapol W. Fluids and diuretics for acute ureteric colic. Cochrane Database Syst Rev. 2012;(2):CD004926. PMID 22336806. doi:10.1002/14651858.CD004926.pub3 Supports: No reliable evidence that forced fluids help in acute colic.
8. NASA Human Research Program. Evidence Report: Risk of Adverse Health Outcomes and Decrements in Performance due to In-Flight Medical Conditions (2017). humanresearchroadmap.nasa.gov/evidence/reports/Medical.pdf Supports: Table 1: 2 dehydration events on the ISS through Expedition 40.
9. NASA. NASA-STD-3001, Space Flight Human-System Standard, Volume 1: Crew Health, Revision C (2023). www.nasa.gov/wp-content/uploads/2023/11/nasa-std-3001-vol-1-… Supports: NASA-STD-3001 Vol 1 Rev C: V1 3003 item a (general health monitoring); V1 3004 items c (privacy), d (history), h (monitoring and trending physiological signs) and m (medicines).
10. NASA OCHMO. Medical Operations. Technical Brief OCHMO-TB-044 (2025). www.nasa.gov/wp-content/uploads/2025/08/ochmo-tb-044-medical… Supports: The crew surgeon keeps medical authority when care is delegated; crew medical officers train on the JSC 48522 medical checklist.
11. NASA. Mars communications disruption and delay (fact sheet, 2023 Moon to Mars Architecture Concept Review). www.nasa.gov/wp-content/uploads/2024/01/mars-communications-… Supports: One-way Earth-Mars delay up to about 21-23 minutes, plus blackouts of about 2-3 weeks near solar conjunction.
12. U.S. Food and Drug Administration. Marketing submission recommendations for a predetermined change control plan for artificial intelligence-enabled device software functions (guidance). www.fda.gov/regulatory-information/search-fda-guidance-docum… Supports: A model for planning, validating and rolling back software updates.
13. U.S. Code of Federal Regulations, Title 14, Part 460: Human space flight requirements. www.ecfr.gov/current/title-14/chapter-III/subchapter-C/part-… Supports: Federal rules for crew and spaceflight participants on licensed commercial flights; they set no medical standards for spaceflight participants.

Checked on 2026-10-20: links opened (HTTP 200 or publisher redirect), DOIs and PubMed IDs matched, NASA documents read in full text. The framework comes from Part 1.