A 74-year-old woman has symptoms of shortness of breath on exertion and waking up at night. Her physical examination reveals a JVP at 8 cm, extra third heart sound, lung crackles, and pedal edema. She is started on furosemide 80 mg/day for heart failure, while further investigations are performed.For the above patient with new symptoms, select the most likely acid base disorder.

**Core Concept**
The patient has been diagnosed with heart failure and is being treated with furosemide, a loop diuretic. Loop diuretics act by inhibiting the sodium-potassium-chloride cotransporter in the thick ascending limb of the loop of Henle, leading to increased excretion of sodium, chloride, potassium, and water. This treatment can lead to changes in acid-base balance.

**Why the Correct Answer is Right**
The patient is likely to develop metabolic alkalosis due to the effects of furosemide. Furosemide causes a contraction alkalosis, characterized by a decrease in chloride reabsorption and a subsequent increase in bicarbonate reabsorption in the proximal tubule. This leads to an increase in plasma bicarbonate levels and a decrease in hydrogen ion concentration, resulting in metabolic alkalosis. Additionally, the loss of potassium ions through the urine can lead to hypokalemia, which can further contribute to the development of metabolic alkalosis.

**Why Each Wrong Option is Incorrect**
**Option A:** Metabolic acidosis is unlikely in this scenario, as the patient is not expected to develop a condition that leads to an increase in anion gap or a decrease in plasma bicarbonate levels.

**Option C:** Respiratory acidosis is not related to the treatment with furosemide and is characterized by an increase in CO2 levels in the blood, which is not consistent with the patient's symptoms.

**Option D:** Respiratory alkalosis is also not related to the treatment with furosemide and is characterized by a decrease in CO2 levels in the blood, which is not consistent with the patient's symptoms.

**Clinical Pearl / High-Yield Fact**
It is essential to remember that loop diuretics can cause metabolic alkalosis due to the contraction alkalosis effect, and this should be considered when interpreting acid-base disturbances in patients treated with these medications.

**✓ Correct Answer: B. metabolic alkalosis**

✓ Correct Answer: B. metabolic alkalosis