Introduction: Adult comatose patients are challenging in General Medicine ward. Proper and prompt handling of such patients is important to get the best results. To reach etiological diagnosis early is important for the outcome. Methods: It is an observational, analytical, prospective study among 300 adult non-traumatic comatose patients (GCS __ampersandsignle; 10) admitted in the Medical ward. Cases were evaluated with details history, clinical examinations, investigations. The etiological and immediate outcome was assessed. Results: In our study, most common causes were stroke (48.99%) followed by metabolic derangement (28.98%), infection (14.3%), poisoning (5.66%) and malignancy (2%). Among death patients, stroke is in the top (71.1%) then metabolic causes (13.32%), infection (7.4%), poisoning (5.92%), malignancy (2.22%). Among 300 patients 32% had one or more co-morbid illness. Conclusion: Stroke is the most common cause of non-traumatic coma but metabolic and infective causes are equally important in a tertiary care hospital.