Although the frequency of recognition of the syndrome of non-ketotic hyperosmolar coma is increasing in all age groups the mortality rate remains high. This paper reports the occurrence of this syndrome in a 12-year-old girl. The pathogenesis is discussed and a planned approach to the management of circulatory collapse, hypokalemia, hyperglycemia and hyperosmolarity over the initial 24 hours is proposed. The phenomenon of insulin resistance which was observed in this case is a rare complication of this syndrome. Awareness of the occurrence of this syndrome in all age groups, early recognition of its features and a planned approach to management are mandatory to reduce the very high mortality rate.