A 6-year-old male castrated alpaca weighing 87.3 kg was presented in early January to the University of Missouri, Food Animal Clinic with a history of anorexia, lethargy, weight loss, and obstipation of 6 days duration. The owner reported that the alpaca preferred to lay in lateral recumbency and was unwilling to cush. The alpaca shared a pasture of fescue and orchard grass with 2 intact male alpacas for the previous 5 years. All 3 alpacas were fed a grain mix (consisting of cracked corn, wheat, and oats), llama pellets, and free choice alfalfa hay. The hay was obtained locally, consisted of fescue and orchard grass, and was typically fed only during the winter. A heated, automatic waterer had been installed 2 years previously and was supplied by well water. The alpaca pasture had fenceline contact with 2 horses. There were no other changes in environment or management, and no other animals were reportedly affected.The alpaca was weak with generalized muscle tremors and was showing signs of lethargy. Gut sounds were absent, and abdominal ballottement and palpation were resented. On digital rectal palpation, hard dry fecal pellets were present and adhered to the rectal wall, with no evidence of mucous coating. Both of the alpaca's eyes were sunken and the ocular conjunctivae were bilaterally reddened. Skin fold relaxed within normal time limits (o 2 seconds). No signs of ataxia or cranial nerve deficits were noted. Pupils were normally dilated with an appropriate pupillary light response, and there was no evidence of ptosis. There was a small amount of foam around the mouth, which the owner had noticed before admission. Food material was present in the oral cavity and buccal pouches. The body condition score was 2.5/5 (3/5 considered optimal).Initial differential diagnoses included gastrointestinal (GI) obstruction or impaction, abdominal neoplasia, and dysautonomia. Clinical similarities to a llama previously diagnosed with dysautonomia 1 and other unreported cases in this hospital created a strong suspicion of dysautonomia in this animal.Initial treatment consisted of fluid therapy (Lactated Ringer's solution a at 360 mL/h); an enema (60 mL warm water with soap) was administered at the start of hospitalization, and again 6 hours later (without soap) when no defecation was detected. The alpaca was offered free choice hay and water, and was hospitalized overnight.There was hyperglycemia (495 mg/dL, reference range 76-176), hyponatremia (145 mEq/L, reference range 148-158), low total serum CO 2 concentration (total CO 2 of 17 mEq/L, reference range 24-34), and a stress leukogram (16,560 neutrophils/mL, reference range 4,600-16,000; lymphocytes 350/mL, reference range 1,000-7,500). There was a single Nematodirus sp. egg in feces, equivalent to 5 eggs/g of feces.There was no apparent improvement in clinical signs during the 2nd day of hospitalization. Dysphagia was observed in that the alpaca successfully prehended hay and attempted to drink, but water and masticated food either fell out of the alpaca's mouth or wer...