A 3-day old male alpaca cria presented for examination for a 1 day history of lethargy, decreased nursing, disorientation with attempts to nurse at the wrong alpaca, and increased rectal temperature of 104 degrees Fahrenheit. The cria was born at term via dystocia (breech) and was unable to breathe immediately after birth due to mucus accumulation in the upper airways. IgG level was adequate greater than 24 hours after birth. Physical examination revealed hyperthermia at 104.2°F. He was observed to latch and nurse well during exam. Initial diagnostics showed hypernatremia (158 mmol/L), hyperchloremia (123 mmol/L), hyperglycemia (498 mg/dL), and glucosuria (2+). Differentials include hypoxic-ischemic encephalopathy, sepsis, hyperosmolar syndrome, septic meningoencephalitis, and polioencephalomalacia. Hyperosmolar syndrome in camelids occurs as a result of a stressful event and the camelid’s decreased ability to regulate blood glucose levels in combination with a decreased fluid intake. In this case, it is suspected that the dystocia and the inability to breathe immediately after birth caused this cria to develop hypoxic- ischemic encephalopathy. The subsequent decrease in intake due to altered mentation (lethargy, nursing at the wrong alpacas) led to hyperosmolar syndrome. The cria was treated with a constant rate infusion of insulin and hypo-osmolar fluid therapy, which successfully lowered the blood glucose and normalized electrolytes. Antibiotics were also administered for suspicion of infection and sepsis. The cria was weaned off the insulin CRI after two days and was able to regulate his blood glucose without further treatment.