A 4-day-old male Alpaca cria presented on emergency to the Cornell University Equine and Farm Animal Hospital for failure of passive transfer and an outpatient plasma transfusion. The cria was depressed, febrile and tachycardic on presentation with tacky and injected mucous membranes. There were constant fine tremors of the head and neck. Laboratory data revealed hypernatremia, hyperglycemia and a metabolic acidosis. Initial therapy included a plasma transfusion, broad spectrum antibiotics and nasogastric tube feeding of caprine milk replacer. Following initial therapy, the cria became severely hyperglycemic and glucosuric, resulting in a diagnosis of hyperosmolar syndrome. A constant rate infusion of insulin was administered and blood glucose and sodium concentrations were successfully lowered. Within 48 hours, the cria’s clinical signs had resolved, he improved steadily and was discharged 6 days after admission. This case will be used to discuss hyperglycemia and hyperosmolar syndrome in neonatal camelids.