ER fluid showdown: which IV fluid saves more sepsis patients?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * Adult male or female patients (≥18 years of age) presenting to the emergency department. * Diagnosed or suspected sepsis secondary to an infectious cause. * Provision of written informed consent by the patient, or if the patient is unable to consent, by a first-degree relative or legally authorized representative. Exclusion Criteria: * Age under 18 years old. * Pregnant women. * Informed consent was not obtained from the patient or their first-degree relative/legal guardian. * Patients who are receiving cardiopulmonary resuscitation (CPR) or who require endotracheal intubation at the time of presentation. * Patients with severe volume depletion unrelated to sepsis (e.g., diabetic ketoacidosis, burns, or active gastrointestinal bleeding). * Patients with severe hyperkalemia (serum potassium level of at least 6.5 mmol/L with ECG changes). * Patients with hypotension that is not related to sepsis (e.g., active hemorrhage or intracranial bleeding). * Patients with clinical signs of pulmonary edema or congestive heart failure. * Cases in which the treating physician determines that one isotonic crystalloid (Ringer's lactate or 0.9% NaCl) is clearly superior to the other due to clinical condition or comorbidities. * Cases in which the treating physician anticipates that fluid therapy might be delayed due to study participation. * Patients requiring immediate hospital or ICU admission before completion of initial emergency department resuscitation. * Patients with sepsis sources requiring urgent invasive intervention known to directly affect mortality (e.g., an undrainable abscess or osteomyelitis). Additional exclusion criteria based on the contraindications listed in the Ringer's lactate product information:, * Known hypersensitivity to sodium lactate. * Extracellular hyperhydration or hypervolemia. * Severe renal failure with oliguria or anuria. * Decompensated heart failure. * Hypercalcemia. * Metabolic alkalosis or severe metabolic acidosis. * Conditions associated with impaired lactate metabolism, such as lactic acidosis, severe liver failure, and cirrhosis with ascites. * Current use of digitalis preparations (e.g., digoxin).