Diuretic Effect of Metolazone Pre-dosing Versus Concurrent Dosing

Inclusion Criteria: * Admission within 48 hours for acute decompensated heart failure with at least one symptom and one sign of volume overload * Receipt of loop diuretic prior to admission * Plan to administer furosemide 120 - 160 mg IV bolus twice daily over the next 24 hours with additional diuresis deemed necessary * If patient is concurrently administered intravenous vasodilator or inotrope, the dose of vasodilator or inotrope must be stable for 6 hours prior to enrollment with a plan to continue the same dose for the 24 hour duration of this study Exclusion Criteria: * Metolazone prescribed prior to admission * Receipt of continuous intravenous infusion of furosemide * Cirrhosis or end stage renal disease * Non-English speaking patients