Knowledge of medical conditions that affect camelids has increased greatly in recent years. However, sometimes the first signs of illness in camelids can be subtle and nonspecific or animals may be found dead with no abnormalities observed. The purpose of this study was to catalog the fatal conditions seen in camelids in the Upper Midwest in order to recognize trends and ultimately to prevent disease. The reports of 234 alpacas and 125 llamas submitted to the University of Minnesota Veterinary Diagnostic Laboratory (UM VDL) for post‐mortem examination from 2001 to 2011 were reviewed. The cause of death was identified in 73% of the cases. The digestive system was the most common site of the major disease condition, accounting for 29% of alpacas and 31% of llamas. In adults, gastrointestinal parasitism associated with emaciation, neoplasia, and hepatic lipidosis were among the most common diagnoses identified. Meningeal worm (<italic>P. tenuis</italic>) was the most commonly identified cause of death associated with the nervous system in adults, since 13% of llamas and 2.4% of alpacas had central nervous system lesions consistent with verminous migration. The most common cause of death or euthanasia among alpaca crias was choanal atresia, which accounted for mortality in 19% of alpacas under 6 months of age. Other congenital abnormalities and bacterial infections were also common in neonates. In older crias (age 2 weeks to 6 months), enteritis and septicemia were most common. In conclusion, necropsy evaluation was successful in identifying the cause of death in the majority of camelids submitted to the UM VDL. The risk of morbidity or mortality related to many of the most common diseases identified in this study can be reduced by taking steps to ensure good husbandry practices, including close monitoring of body condition score, regular fecal testing to identify parasite burdens, basic biosecurity measures to limit spread of pathogens, and IgG measurement to ensure adequate passive transfer of immunity.