The red mud accident of October 4, 2010, in Ajka (Hungary) contaminated a vast area with caustic, saline red mud (pH 12) that contains several toxic trace metals above soil limits. Red mud was characterized and its toxicity for plants was measured to evaluate the soil contamination risks. Red mud radioactivity (e.g., U-238) is about 10-fold above soil background and previous assessments revealed that radiation risk is limited to indoor radon. The plant toxicity and trace metal availability was tested with mixtures of this red mud and a local noncontaminated soil up to a 16% dry weight fraction. Increasing red mud applications increased soil pH to maximally 8.3 and soil solution EC to 12 dS m(-1). Shoot yield of barley seedlings was affected by 25% at 5% red mud in soil and above. Red mud increased shoot Cu, Cr, Fe, and Ni concentrations; however, none of these exceed toxic limits reported elsewhere. Moreover, NaOH amended reference treatments showed similar yield reductions and similar changes in shoot composition. Foliar diagnostics suggest that Na (> 1% in affected plants) is the prime cause of growth effects in red mud and in corresponding NaOH amended soils. Shoot Cd and Pb concentrations decreased by increasing applications or were unaffected. Leaching amended soils (3 pore volumes) did not completely remove the Na injury, likely because soil structure was deteriorated. The foliar composition and the NaOH reference experiment allow concluding that the Na salinity, not the trace metal contamination, is the main concern for this red mud in soil.