Soluble barium salts, such as barium carbonate, nitrate, acetate, and chloride, have various industrial applications, including the manufacture of ceramics, insecticides, and rodenticides. However, these salts are highly toxic to humans if ingested, making acute soluble barium poisoning a life-threatening condition. The toxic effects of barium salts can be severe, with a fatal dose of barium chloride reported to be as low as 0.8 to 0.9 grams. Despite the potential dangers, there is a lack of systematic studies on acute soluble barium poisoning, highlighting the need for more research and awareness about this condition. The toxicological characteristics of acute soluble barium poisoning are complex and multifaceted. Barium acts as a competitive blocker of potassium inward rectifier channels, leading to an inhibition of potassium efflux and resulting in profound hypokalemia. This can cause a range of symptoms, including gastrointestinal effects such as vomiting and diarrhea, followed by more severe hemodynamic disturbances, cardiac arrhythmias, muscle weakness, and cardiac arrest. Respiratory failure induced by muscle paralysis is a major cause of death in cases of acute soluble barium poisoning. Management strategies for this condition are crucial and include prevention of barium absorption, administration of soluble sulfates, potassium supplementation, antiarrhythmic medications, hemodialysis, and cardiorespiratory support. Timely administration of decontamination and correction of hypokalemia are two critical points in the treatment of acute soluble barium poisoning. By understanding the clinical features and management of this condition, healthcare professionals can provide more effective treatment and improve outcomes for patients affected by acute soluble barium poisoning. This narrative review aims to provide crucial information for treating patients with this condition, highlighting the importance of prompt and targeted intervention. Link: https://pubmed.ncbi.nlm.nih.gov/40410153/