Diabetic Ketoacidosis (DKA): The presence of 2+ ketones and a glucose level of 132 mg/dL on a glucose strip, along with symptoms of painful urination, suggests DKA, especially in a pediatric patient. DKA is a serious complication of diabetes that can present with hyperglycemia, ketonuria, and metabolic acidosis.

Urinary Tract Infection (UTI): Painful urination (dysuria) is a common symptom of UTIs, which are frequent in pediatric patients. Although the UA does not show typical signs of infection like leukocyte esterase or nitrites, it's essential to consider UTI, especially if other symptoms like frequency, urgency, or abdominal pain are present.
Ketosis due to Other Causes: Ketones can be present due to fasting, starvation, or other metabolic states. However, the combination with hyperglycemia points more towards a diabetic condition.

Septicemia or Sepsis: Although less likely, any child presenting with systemic symptoms (which could include dysuria if associated with a systemic infection) needs to be evaluated for sepsis, a life-threatening condition that requires immediate intervention.
Pyelonephritis: An upper urinary tract infection that can present with severe symptoms, including flank pain, fever, and dysuria. It's crucial to differentiate from lower UTIs due to its potential for more severe complications.

Idiopathic Ketotic Hypoglycemia: A condition more commonly seen in young children, characterized by episodes of hypoglycemia and ketosis, often precipitated by fasting or inadequate food intake. The presence of hyperglycemia in this case makes it less likely.
Other Metabolic Disorders: Such as organic acidemias or fatty acid oxidation disorders, which can present with ketosis but are much rarer and typically have other distinctive clinical features.