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Where a patient’s gastrointestinal tract is wholly non-functional, nutrition is administered intravenously by means of parenteral (i.e. outside the intestinal tract) preparations. Total parenteral nutrition solutions (TPN) are formulated to supply the patient’s complete nutritional requirements. »Ê¹ÚÌåÓýappy use a balance of

• essential and non-essential amino acids (the active constituents of protein),
• carbohydrate (generally one or more of a combination of glucose, sorbitol or alcohol),
• vitamins, and / or
• fat in the form of lipids.

»Ê¹ÚÌåÓýapp liability of parenteral nutrition products is judged by the same criteria as “normalâ€� food. Those which provide sufficient nutritional value to be considered the equivalent of a meal are zero-rated; those which simply provide a vitamin or mineral supplement are treated in the same way as vitamin and mineral supplements taken orally and standard-rated.

To be treated as “food� a PN solution would have to contain:

• amino acids (either alone or with vitamins and minerals); or
• amino acids together with carbohydrates; or
• carbohydrate (e.g. glucose); or
• lipids.

Other combinations are possible. »Ê¹ÚÌåÓýappse solutions will normally be large volume preparations of 100 ml - 1000 ml with, typically, 500 ml - 1000 ml given to an adult over 24 hours.

Supplementary products consisting of single vitamins and / or vitamin-mineral mixes are standard-rated. »Ê¹ÚÌåÓýappse are generally small volume preparations (typically 10 ml - 20 ml) and do not contain significant amounts of nitrogen or carbohydrate.

Most intravenous glucose solutions are eligible for zero-rating as parenteral nutrition products. However, low level glucose solutions (e.g. 5% -10%) are generally not administered for their nutritional content, but are used as carriers for antibiotics etc, added in the hospital immediately before administration. »Ê¹ÚÌåÓýappse carrier solutions are not food, and are standard-rated.

Glucose is also used, in injection, to counter hypoglycaemia (e.g. in diabetic coma). Preparations designed for this application are medicinal not nutritional, and standard-rated. »Ê¹ÚÌåÓýappy will normally be supplied in small quantities of less than 100 ml, often in ready-to-use pre-filled syringes; if you are in any doubt, the accompanying promotional material will identify the intended use of the product.