Mechanism and Effects of Manipulating Chloride Homeostasis in Acute Heart Failure

The purpose of this study is to understand the effects of chloride supplementation on volume-overloaded acute heart failure patients concomitantly treated with IV diuretics.

Inclusion Criteria: * Clinical diagnosis of decompensated heart failure with at least one objective sign of volume overload (rales, edema, elevated jugular venous pressure (JVP), or weight gain of at least 5 pounds) * A projected need by the treating clinician for continued treatment with IV diuretics * Chronic loop diuretic use Exclusion Criteria: * Inability to commit to or comply with serial visits for treatment in the Yale Transitional Care Center (YTCC) * History of severe metabolic or respiratory acidosis within 30 days of enrollment * Use of metformin, acetazolamide, or any other agent that could predispose to acidosis. Patients who are on metformin may be enrolled if their metformin can be discontinued safely for the duration of the study. Any participants who have consistently elevated Blood glucose readings \> 200 mg/dL while inpatient will not be enrolled. * Serum bicarbonate level \